Bottiglieri, Carolyn Elizabeth 31 \
NEW YORK STATE DEPARTMENT OF HEALTH ► �
Bureau of Vital Records -� Burial - Transit Permit
Name First Middle Last Sex
Carolyn Elizabeth Bottiglieri Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/11/2022 91 Years War or Dates
F. Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 175 Robert Gardens North Apt#6,Queensbury Town,New York 12804
Q Manner of Death El Natural Cause Accident Homicide ESuicide Undetermined Pending
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0 Circumstances Investigation
O Medical Certifier Name Title
Connie Goedert Coroner
Address
1400 St Route 9,Lake George Town,New York 12845
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 70
Burial Date Cemetery,Crematory or Facility Name
MIRO 04/14/2022 Pine View Crematory
Entombment Address
Cremation Queensbury,New York
DDonation
ZO❑Removal Date Place Removed
H and/or and/or Held
N Hold Address
0
a Date Point of
N Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F. Remains are Shipped,If Other than Above
N Address
Q
uJ
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/13/2022 Registrar of Vital Statistics Caroline.7fi[Ieganfe Barber(ECectronicalTySigned)
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Z Date of Disposition t(-/c. 'Z 'z t Place of Disposition Pine if t Gu.J G.te.m., s,
W
2 (addfess)
W
(I)
Q (section) (lot number) (grave number)
0 Name of Sexton or Person i Charge of Premises t. t aK t+'r �G
I
Z (please print) /
W Signature �--- Title C r'e i i ecia,y e.-e�`o,,-
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) n
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#