Lovett, Ralph Edward '-' . It its-
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Ralph Edward Lovett Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/13/2023 82 Years War or Dates
H Place of Death Hospital.Institution or
Z City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare
W
p Manner of Death ri Natural Cause Accident Homicide []Suicide Undetermined ❑Pending
W Circumstances Investigation
W Medical Certifier Name Title
0.
Sandita Seecharan MD
Address
A 4573 State,Route 40,Argyle Town,New York 12809
Death Certificate-Filed Town Of Argyle District Number Register Number
City,Town or Village 5750 9
FRBurial bate, Cemetery,Crematory or Facility Name
02/16/2023 Pine View Crematorium
Entombment Address
[]Cremation Queensbury Town,New York
IIIDonation
Z Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
a Date Point of
U) Transportation
Et Common Shipment
Carrier Destination
•
O
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
E— Remains are Shipped,If Other than Above
Address
CC
W
d Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/16/2023 Registrar of Vital Statistics Slid-fey lfckcrnon(ECectronicaCCySigned)
(signature)
District Number 5750 Place Town Of Argyle
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z ,�l"�
W Date of Disposition Z11/ 73 Place of Disposition - i�1L
2 (address)
LU
N
CC /section) �°(lot�number) (grave number)
0 Name of Sexton or Person in Charge f Premises
Z /pe are print/ /
W Signature �-, Title ! �
DOH-1555(07/18)p 1 of 2
F.1ry &.4
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# '