Temple, Lauren Heather NEW YORK STATE DEPARTMENT OF HEALTH „,,,,,..L...:1.) Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Lauren Heather Temple Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/18/2022 41 Years War or Dates
H Place of Death Hospital,Institution or
WCity,Town or Village Schenectady Street Address 917 Bridge Street#2,Schenectady,New York 12303
p Manner of Death 0 Natural Cause ❑Accident ❑Homicide Suicide FlUndetermined Pending
W Circumstances Investigation
LU Medical Certifier Name Title
O Nadarajah Balasubramaniam ME
Address
1101 Nott Street,Schenectady,New York 12308
Death Certificate Filed City Of Schenectady District Number Register Number
City,Town or Village 4601 1033
RBurial Date Cemetery,Crematory or Facility Name
11/22/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
OL. Date Point of
t/) Transportation Shipment
p by Common
Carrier Destination
O
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home In 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
1— 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 11/22/2022 Registrar of Vital Statistics Samanta X Mykgo(E(ectronically Signed)
(signature)
District Number 4601 Place City Of Schenectady
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I/
W Date of Disposition 111231 x 2 Place of Disposition t ��{ -
2 (address)
CC (section) / /!ot number) (grave number)
• Name of Sexton or Person in Charge of Pre ' es [ I)At L.—
Z (pi se print)
W Signature Title if�ma
DOH-1555(07/18)p 1 of 2
M �
016426
Public Health Law Sec. 4145(2b)
Receipt
1
1 Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#