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O'Brien, Linda Mae it,_ _.. i� --) NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Linda Mae O'Brien Female Date of Death Age If Veteran of U.S.Armed Forces, 02/23/2023 82 Years War or Dates i_ Place of Death Hospital,Institution or WCity,Town or Village Fort Edward Town Street Address 325 Broadway 33, Fort Edward Town, New York 12828 p Manner of Death ❑X Natural Cause Accident El Homicide Suicide Undetermined []Pending '1J Circumstances ff ''Investigation U LLICI Medical Certifier Name Title Robert Lemieux Coroner Address 415 Lower Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed Town Of Fort Edward District Number Register Number City,Town or Village 5755 25 RBurial Date Cemetery,Crematory or Facility Name 02/28/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York ▪Donation 0 El Removal Date Place Removed and/or and/or Held F— Hold Address N 0 d Date Point of Cl)[]Transportation p by Common Shipment Carrier Destination Date Cemetery Address Disinterment 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 1— Remains are Shipped,If Other than Above 5 Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/28/2023 Registrar of Vital Statistics ,Aimee£911a(oney(ECectronicalTySigned) (signature) District Number 5755 Place Town Of Fort Edward I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: C I— W Date of Disposition NI 13 Place of Disposition �/t 2 (address) W (I) CC (section) (lot number) (grave number) O Name of Sexton or Person in Charge of Pre ' s L IT Z / ase print) W Signature Title �� ��2 DOH-1555(07/18)p i 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#-