DePalo, Catherine NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Catherine Mary DePalO I I Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/20/2022 60 Years Waror Dates
Place of Death Hospital,Institution;or
Z City,Town or Village New,Hartford Town Street Address Fon-St Lukes Healthcare-St Lukes Division
W Manner of Death Undetermined Pending
W �NaturaLCause ❑Actident Homicide Suicide
W Circumstances Investigation
W Medical Certifier Name Title
0 Madssa KaIll DO
Address
1656 Champlin Ave,New Hartford Town,New York 13502
Death Certificate Filed Town Of New Hartford District Number Register Number
City,Town or Village 1 3264 225
X Burial Date Cemetery,Crematory or Facility Name
04/30/2022 St.Alphonsus Cemetery
Entombment Address
❑Cremation Oueensbury Town,New York
Donation
Z Removal Date Tap—lam Removed
and/or nd/or Held
i- Hold Address
to
O
ca Date Poi ntof
N Transportation Shipment
p by Common
Carrier Destination
[:]Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
66 Main Street,P.O.-Box 67,Hudson Falls,Now York 12839
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped,If Other than Above
5 Address
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IL Permission is hereby granted to dispose of the human remains described above as;indicated.
Date Issued 04=2022 RegistrarofVitalSfatistics ,yade904o/rEYect'vX&4 SrJma)
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District Number 3264 Place Town Of New Hartford
I certify thatthe remains of t e dec ent identified above were disposed of in accordance with this permit n..
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W Date of Disposition , - Place of Disposition 1 �Y�3 Leh DG
/address/
1.
O (section) r7 /!a(lrreuLmbed (gravenumber)
0 Name of Sexton or Per i Charge of Premises
Z /please pant/
W Signature Title
DOH-1555(07/16)p l of 1