McCullough, Margaret Joan .L., ,. -03-7/
NEW YORK STATE DEPARTMENT OF HEALTH Burial -Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Margaret Joan McCullough Female
Date of Death Age If Veteran of U.S.Armed Forces,
O5/03/2022 61 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Moreau Town Street Address 16 Holly Drive,Moreau Town,New York 12831
SManner of Death 0 Natural Cause ❑Accident El Homicide Duicide MUndetermined WIPending
VCircumstances L-Jlnvestigation
W Medical Certifier Name Title
0 Eugene Ladue Coroner
Address
31 Woodlawn Ave.,Saratoga Springs,New York 12866
Death Certificate Filed Town Of Moreau District Number Register Number
,Town or Village Cie 4562 24
Burial Date Cemetery,Crematory or Facility Name
05/05/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
O❑Removal Date Place Removed
and/or and/or Held
NHold Address
2 Date Point of
til❑Transportation Shipment
Q by Common
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
0Reinterment
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Fags,New York 12839
Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped,If Other than Above
5 Address
CC
le
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/05/2022 Registrar of Vital Statistics Lanarrm.ifcca6e(Electrnrruv/1yS
(signature)
District Number 4562 Place Town Of Moreau
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:Date of Disposition .5-6-eezz Place of Disposition Ti of e `"G-..) (. /Y��n. It t`�
w /ee essl J
W
CO (section) (lot lumber) (grate number)
8 Name of Sexton or Person in Charg Premi es fi'1/V044/D tr,
z �� Leese print/
IW
Signature 5, Title (j(ere'v
DOH-1555(o7/18)p 1 of 2
"k `3 4a
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#