Simpson, Natalie J ,-LF
NEW YORK STATE DEPARTMENT OF HEALTH ! Burial-Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Natalie J.Simpson
Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/22/2022 95 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Queensbury Town Street Address Glens Falls Center for Rehabilitation and Nursing
0 Manner of Death ID Natural Cause DAccident OHomicide Suicide ElUndetermined ❑Pending
8Circumstances Investigation
fir Medical Certifier Name Title
C Wendy Steinhacker PA
Address
152 Sherman Ave,Queensbury Town,New York 12801
Death Certificate Filed Town Of Queensbury District Number Register Number
Ci ,Town or Ville 5657 78
Burial Date Cemetery,Crematory or Facility Name
04f15r2022 Pine View Crematorium
Entombment Address
['cremation Queensbury Town,New York
DDonation
FiRemoval Date Place Removed
and/or and/or Held
F- Hold Address
N
Date Point of
(� Transportation Shipment
a by Common
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
n Reinterment
f-Pee'rmit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Fels,New York 12839
Name of Funeral Firm Making Disposition or to Whom
j... Remains are Shipped,If Other than Above
IAddress
W
CL' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/25/2022 Registrar of Vital Statistics Calane IfifiegankBader(Thctnotr SOnsa9
/signature)
District Number 5657 Place Town Of Oueensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I)— f'
2 Date of Disposition 'I iZ�(zz Place of Disposition 47—
aduress)
W Sv6iffQ /section/ /�/twpumbe� (grave number)
Name of Sexton or Person in Cha of Premises (plea scirin!/
z1 4
fJl Signature Title
DOH 1555(07/18)p 1of 2
Public Health Law Sec. 4145(2b)
Receipt
1
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on lural permit
Official Funeral Directors Reg.or License#