Woodacre, Beverly Avis . i- ss-)
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Beverly Avis Woodacre Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/13/2022 92 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Granville Villa, Street Address Granville Center for Rehabilitation and Nursing
IU
p Manner of Death El Natural Cause Homicide Suicide Undetermined ❑Pending
Circumstances Investigation
al Medical Certifier Name Title
0 Shardul Ko. DO
Address
17 Madison St,Granville Village,New Yo 1 •
Death Certificate Filed Village Of Granville District Number Register Number
City,Town or Village 5725 29
Burial Date Cemetery,Crematory or Facility Name
® 07/14/2022 I Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
ZRemoval Date Place Removed
p and/or and/or Held
N Hold Address
0
a Date 1Point of
N 1Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
EIReinterment 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 Fails,New York 12839
Name of Funeral Firm Making Dispositioi or to Whom
H Remains are Shipped,If Other than Above
S Address
Q
W
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/14/2022 Registrar of Vital Statistics `Richard Rpberts(ECectronica1tySigned)
(signature)
District Number 5725 Place Village Of Granville
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W~ , ►a`-
Date of Disposition '� S I ZZ Place of Disposition ,,�'��
(a dress)
W
Cl) (section) (lot pumber) (grave number)
Name of Sexton or Person in Charge o emisesr St-
�
Z
(p ase print)
W (414
Signature Title IN —Ple
DOH-1555(07/18)p 1 of 2
�� Fii.lNlri )IJL� _,r; 63
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery 'epresenting the funeral home named on burial permit
Official Funeral Directors Reg.or License#