Fenton, Mark Joseph NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Mark Joseph Fenton Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/19/2023 65 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Hudson Falls Village Street Address 145 John Street, Hudson Falls Village, New York 12839
p Manner of Death IJNaturalCause ❑Accident Homicide ESuicide Undetermined riPending
(W) Circumstances Investigation
WQ Medical Certifier Name Title
Darci Gaiotti-Grubbs MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed Village Of Hudson Falls District Number Register Number
City,Town or Village 5726 3
Burial Date Cemetery,Crematory or Facility Name
01/21/2023 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
8❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
O. Date Point of
(/)❑Transportation
p by Common Shipment
Carrier Destination
Disinterment
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
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/20/2023 Registrar of Vital Statistics Cynthia Bardin(E(ectronicalfy Signed)
(signature)
District Number 5726 Place Village Of Hudson Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition /2/-2023 Place of Disposition lie et` ,4d
2 "laddre /�
IW
Cr N (section) (11 num r) (grave number)
GName of Sexton or Person in Charge o remises (W40/0/1// it/apJ
Z (please print)
W Signature Title D� r
DOH-1555(07/18)p 1 of 2
16 �''`r°*�P1 F^T
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#-