Malan, Julie Martin CLE
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Julie Martin Malan Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/15/2023 67 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 46 Laurel Lane,Queensbury Town,New York 12804
CI Manner of Death Undetermined Pending
]Natural Cause Accident ]Homicide Suicide
W Circumstances Investigation
W Medical Certifier Name Title
Darci Gaiotti-Grubbs MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 27
Burial Date Cemetery,Crematory or Facility Name
02/21/2023 Pine View Crematorium
Entombment Address
]Cremation Queensbury Town,New York
Donation
OZ Removal Date Place Removed
and/or and/or Held
Hold Address
0
C- Date Point of
(Q]Transportation
p by Common Shipment
Carrier Destination
]Disinterment
Date Cemetery Address
Date Cemetery Address
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
H Remains are Shipped,If Other than Above
2 Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/16/2023 Registrar of Vital Statistics Caroline.71ildegarde(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:
W Date of Disposition 2/21(73 Place of Disposition
address/
W
O (section) /tt_
M �llo t number) (grave number)
11
g Name of Sexton or Person in Charge of P mises —\�`'`'
Z I lease print)
W Title (r (1)ii tA7
Signature
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# _