Cavooris, Catherine Georgette 11 —.)I) 7
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N E W YO RK STATE DEPARTMENT OF H EALTH `�
Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Catherine Georgette Cavooris Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/24/2022 59 Years War or Dates
F. Place of Death Hospital,Institution or
Z City,Town or Village Granville Town Street Address Slate Valley Center for Rehabilitation and Nursing
Manner of Death a Natural Cause ❑Accident Homicide OSuicide Undetermined ❑Pending
W Circumstances Investigation
WMedical Certifier Name Title
O Shardul Koppar DO
Address
10421 State Route 40,Granville Town,New York 12832
Death Certificate Filed Town Of Gramme District Number Register Number
Cit ,Town or Viltaje 5756 60
Burial Date Cemetery,Crematory or Facility Name
091
27I2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Don ation
8❑Removal Date Place Removed
F and/or and/or Held
En- Hold Address
0
d Date Poi nt of
to❑Transportation
El Common Shipment
Carrier Destination
Eaisinterment
Date Cemetery Address
El Re interment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kamer Funeral Home-Fort Edward 01079
Address
82 Broadway,Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
1.— Remains are Shipped,If Other than Above
5 Address
CC
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/27/2022 Registrar of Vital Statistics fOltny L.thlk Al afysigrrsd)
(signature)
District Number 5756 Place Town Of Granville
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ��J+
WDate of Disposition 1,IZB(21 Place of Disposition Pi AAV1,,.. /Alru_
2 (address)
W
(I)
CC (section) A (lot number) (grare number)
SName of Sexton or Person in Charge of Premises f/11�pltp t) " ti
W Signature Title ( ►'►tii°2
DOH-1555(07/18)p 1 of 2
7
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#