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Underwood, Doris Joan # 3a j NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Doris Joan Underwood Female Date of Death Age If Veteran of U.S.Armed Forces, 04/02/2023 90 Years War or Dates F Place of Death Hospital,Institution or Z City,Town or Village Hudson Falls Village Street Address 37 Martindale Avenue,Hudson Falls Village,New York 12839 WW Manner of Death Z Natural Cause Accident O Homicide OSuicide FlUndetermined Pending V Circumstances Investigation WG Medical Certifier Name Title Rita All NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Village Of Hudson Falls District Number Register Number City,Town or Village 5726 8 BurialE] Date Cemetery,Crematory or Facility Name 04/04/2023 Pine View Crematorium -' Entombment Address ©Cremation Queensbury Town,New York ▪Donation ZO Removal Date Place Removed and/or and/or Held F Hold Address N 0 Q. Date Point of Cl)ElTransportation p by Common Shipment Carrier Destination 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 F Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/04/2023 Registrar of Vital Statistics Cynthia Bardin(ECectronica1TySigned) (signature) District Number 5726 Place Village Of Hudson Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F Z Date of Disposition y I s(�3 Place of Disposition _ 2 (ddress W CC CC (section) (lot number) (grave number) 8 Name of Sexton or Person in Char of Premises _9.----- .' t i Z Release print) W Signature iI/ Title [ltgriturviz DOH-1555(07/18)p 1 of 2 • JR' Public Health Law Sec. 4145(2b) Receipt Human remains of 1 delivered on , 20 Pine View Cemetery Representing the funeral home name,,oppiria) rmit Official Funeral Directors Reg.or License#