Winslow, Janet Helen 4 '',-,- — b." 7c.
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Janet Helen Winslow Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/18/2023 84 Years War or Dates
l— Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 3 Quarry Crossing, Queensbury Town, New York 12839
all
pManner of Death ri Natural Cause []Accident n Homicide []Suicide []Undetermined ❑Pending
U I (Circumstances Investigation
W Medical Certifier Name Title
CI Anthony Petracca MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 12
Burial Date Cemetery,Crematory or Facility Name
01/20/2023 Pine View Crematorium
[]Entombment Address
[ ]Cremation Queensbury Town,New York
EiDonation
Z❑Removal Date Place Removed
and/or and/or Held
I Hold Address
U)
0
d. Date Point of
V)❑Transportation
Ci by Common Shipment
Carrier Destination
ElDisinterment Date Cemetery Address
Date Cemetery Address
E Reinterment
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
5 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/20/2023 Registrar of Vital Statistics Caroline Jlitfegarfe(Barber('Electronically Signed)
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H �� (
W Date of Disposition I�ZH(� Place of Disposition ll (...L
2 (address/
W
U)
CC (section) / (!otnumber/ (grave number)
0 Name of Sexton or Person in Cha e o emises / L ��
Z (p, ase print)
Ltl Signature Title itienii10q
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#