Birinyi, Christine , , •r 64, i
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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Christine Birinyi Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/30/2022 52 Years War or Dates
i_ Place of Death Hospital,Institution or
Z City,Town or Village Hadley Town Street Address 6305 Route 9 N, Hadley Town,New York 12835
LU
p Manner of Death Ill Natural Cause Accident Homicide Suicide Undetermined ❑Pending
W Circumstances Investigation
W Medical Certifier Name Title
0 Jennifer Hayes MD
Address
200 Smith Drive,Corinth Town,New York 12822
Death Certificate Filed Town Of Hadley District Number Register Number
City,Town or Village 4558 5
EiBurial Date Cemetery,Crematory or Facility Name
08/05/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
IIIDonation
ZZo Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
0
d. Date Point of
(A Transportation
CI Common Shipment
Carrier Destination
O
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 Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
2 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/04/2022 Registrar of Vital Statistics Co/Teen cDemarsh(ETectronicaCTySigned)
(signature)
District Number 4558 Place Town Of Hadley
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Z Z Date of Disposition Place of Disposition } ,Je 0Gc-- 4• Ai
W (address)
W
CC CC (section 1 (lot umber) (grave number)
gName of Sexton or Person in Char of PremishT i7®.'�� Wood
z (please print)
W
Signature Title ells
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
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C.
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#