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Clodfelter, Carolyn (BO NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Carolyn Clodfelter Female Date of Death Age If Veteran of U.S.Armed Forces, 02/22/2023 78 Years War or Dates H Place of Death Hospital,Institution or ILI Z City,Town or Village Glens Falls Street Address Glens Falls Hospital Q Manner of Death 0 Natural Cause Accident Homicide Suicide ❑Undetermined Pending IU 0 Circumstances Investigation G Medical Certifier Name Title Marvin Davidowitz MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 100 BurialR Date Cemetery,Crematory or Facility Name 62/25/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ❑Removal Date Place Removed H and/or and/or Held N Hold Address 0 a Date Point of (I) Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address ❑Reinterment Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom F— Remains are Shipped,If Other than Above N Address CC n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/24/2023 Registrar of Vital Statistics Megan g ctronicalry Signed) (signature) District Number 5601 Place City Of Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— � Z Date of Disposition ZZ5_202, Place of Disposition rt ,Je v,e C.'- A-1-e q 2 (address) W U) Q (section) jnumber) (grave number) Name of Sexton or Person in Charge of Prem' �tl y!(�.A)b Z /plearinf/ W Signature g � � Title C)e-Cril n�- DOH-1555(07/18)p 1 of 2 fJ J 736 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 f; Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#