Plude, Arlene Mary 411 -71fr Si g
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Arlene Mary Plude Female
Date of Death Age If Veteran of U.S.Armed Forces,
06/27/2022 62 Years War or Dates
�.. Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
IJJ
Manner of Death II Natural Cause IllAccident Homicide OSuicide Undetermined ❑Pending
ILI
C.) Circumstances Investigation
Q Medical Certifier Name Title
William Cleaver 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 338
Burial Date Cemetery,Crematory or Facility Name
06/29/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
❑Removal Date Place Removed
and/or and/or Held
Hold Address
CO
O
O. Date Point of
!n ETransportation
by Common Shipment
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
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
a Address
Q
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/29/2022 Registrar of Vital Statistics ,tegan.9lro1in(E(ectronicaltySigned)
(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:
Il-
Z Date of Disposition 3O-Zo•ZZ Place of Disposition ?off P VjJ Cre0!►'tt;,/v
0,11
2 (addressLd
W
CC W (section) 11 (lot number) (grave number)
gName of Sexton or Person in Charge f Pre .ses /40 D.,%i d JOCY'1
(please print)
W Signature Title dCC-rodo r
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
I
Human remains of delivered on ` , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#