Collette, Theodore Harvey t S3-?'
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NEW YORK STATE DEPARTMENT OF HEALTH NEW - Transit Permit
Bureau of Vital Records Sex
Middle Last
Name First Male
Theodore Harvey Collette
If Veteran of U.S.Armed Forces,
Date of Death Age 07/05/2022 79 Years War or Dates 1964-1970
Hospital,Institution or
H Place of Death Street Address 26 Rock Rose Way,Malta Town,New York 12020
Z City,Town or Village Malta Town ❑Undetermined ❑Pending
Accident Homicide Suicide Investigation
p Manner of Death EllNatural Cause Circumstances g
Ui Title
W Medical Certifier Name MD
CIAlexandra Aarons
Address
3 Irongate Center,Glens Falls,New York 12801 District Number Register Number
Death Certificate Filed Town Of Malta 4560 . 39
City,Town or Village
■Burial
Date Cemetery,Crematory or Facility Name
07/07/2022 Pine View Crematorium __
Entombment Address
nCremation Queensbury Town,New York
Donation
Date Place Removed
ZO Removal and/or Held
and/or
1— Hold Address
ii)0
n, Date
I Point of
Cl)❑Transportation Shipment
p by Common
Carrier Destination
Date Cemetery Address
nDisinterment
Date Cemetery Address
Reinterment
Permit Issued to Registration Number
Carleton Funeral Home Inc 00281
Name of Funeral Home
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped,If Other than Above
g Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/07/2022 Registrar of Vital Statistics Jennifer Ma tie Wofines(Electr'nwa1(y Signed)
rsignature/
District Number 4560 Place Town Of Malta
I certify that the remains of the decedent identified above were disposed of in accordance with this AeRqilOp;
1—
W Date of Disposition -- q t Ftaceoi i
W -�f—Q isposition tICC
444.44
p Name of �'•
Sexton or Person it —vies
W of s: _
7rge
s
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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Theodore Harvey Collette Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/05/2022 79 Years War or Dates 1964-1970
H Place of Death Hospital,Institution or
WCity,Town or Village Malta Town Street Address 26 Rock Rose Way,Malta Town, New York 12020
p Manner of Death ❑X Natural Cause []Accident []Homicide []Suicide []Undetermined Pending
W Circumstances Investigation
U
W Medical Certifier Name Title
0 Alexandra Aarons MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed Town Of Malta District Number Register Number
City,Town or Village 4560 • 39
Burial Date Cemetery,Crematory or Facility Name
07/07/2022 Pine View Crematorium
[]Entombment Address
[]Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
n. Date Point of
Cl)❑Transportation
p by Common Shipment
Carrier Destination
[]Disinterment
Date Cemetery Address
pi 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
I— Remains are Shipped,If Other than Above
5 Address
CC
W
C' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/07/2022 Registrar of Vital Statistics Jennifer.Marie 7fot nes(Electronically Signed)
(signature)
District Number 4560 Place Town Of Malta
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
WDate
Date of Disposition 7',,rat Place of Disposition e Ae tr`Q� `/ -Grsto -IV. I-
r2 (address)
W
N CC (section) (lot number)�7 (grave number)
-/
O Name of Sexton or Person in Ch rge of Pre s 1C 41pA) IA)
(please print)
Z
W Signaturek) V
Title O�-ero�"} ) C.
DOH-1555(07/18)p 1 of 2 v
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#