Rosebrook, Naomie Lynn 11300
12.14
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
If'ame First Middle Last Sex
Naomie Lynn Rosebrook Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/02/2022 45 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death J Natural Cause ❑Accident Homicide Suicide Undetermined Pending
W
0 Circumstances Investigation
CI
Medical Certifier Name Title
Marcille Labban MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 197
EIBurial Date Cemetery,Crematory or Facility Name
04/06/2022 Pine View Crematorium
Entombment Address
Cremation QueeNisbury Town,New York
Donation
goRemoval Date Place Removed
and/or and/or Held
I--N Hold Address
0
11 Date Point of
t1NTransportation
ES Common Shipment
Carrier Destination
ODisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped,If Other than Above
2 Address
Cr
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/06/2022 Registrar of Vital Statistics Megan Nolin(ECectronicalfy Signed)
(signature/
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
rJ
W Date of Disposition '—jL'feZL, Place of Disposition it Jig tie ea) Cl 4
2 (address)
W
cc N /section/ RA OV /lot nu ber/ (grave number)
��Name of Sexton or Person in Charge o remis IJrJ
Zr r /please print/
W G�1 Signature Title QJ'l`"t'D�
i
DOH-1555(07/18)pi of 2
Public Health Law Sec. 4145(2b)
1
1
Receipt
Human remains of ` delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#