Allen, Karen Ann NEW YORKSTATE DEPARTMENT OF HEALTH I
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Karen Ann Allen Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/12/2022 55 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital
p Manner of Death ❑X Natural Cause ❑Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
G Hung Nguyen MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed City Of Saratoga Springs District Number Register Number
City,Town or Village 4501 732
Burial Date Cemetery,Crematory or Facility Name
12/14/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
8❑Removal Date Place Removed
and/or and/or Held
H Hold Address
0
O. Date Point of
N Transportation Shipment
Q by Common
Carrier Destination
ElDisinterment 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
F Remains are Shipped,If Other than Above
2 Address
CC
Lu
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/14/2022 Registrar of Vital Statistics Di/Ton Moran(ECectronically Signed)
(signature)
District Number 4501 Place City Of Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition /Z/b-Zozz Place of Disposition �� �e Vl,`e-f
2 (address) +�
W
CC CC (section) (/ot umber) (grave number)
,f JJ
gName of Sexton or Person in Charge Premi e 't4Y1d JT l 1VC`
Z (please print)
W Signature cs �� K-Title C
DOH-1555(07/18)p 1 of 2 �/�
.
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#