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Titchen-Studenka, Leilani Elizabeth #fi Li(O . '.. t'N'T NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Leilani Elizabeth Titchen-Studenka Female Date of Death Age If Veteran of U.S.Armed Forces, 06/07/2023 61 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Hudson Falls Village Street Address 16 Baker Street Apt.D,Hudson Falls Village,New York 12839 UJ p Manner of Death 1=1Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Illnvestigation W Medical Certifier Name Title Q Robert Lemieux Coroner Address 415 Lower Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed Village Of Hudson Falls District Number Register Number City,Town or Village 5726 16 Burial Date Cemetery,Crematory or Facility Name 06/09/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York DDonation Z❑Removal Date Place Removed and/or and/or Held H Hold Address CO 0 d Date Point of Cl)ElTransportation El by Common Shipment Carrier Destination El 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 H Remains are Shipped,If Other than Above N Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/09/2023 Registrar of Vital Statistics Cynthia cBard n(ECectronicaCCy Signed) (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: I— Z Date of Disposition 6/0-z72, Place of Disposition t, re__ ✓:e,,,.) Creiept j en W 2 (address) W U) CC (section) ✓ /lot nu be) (grave number) gName of Sexton or Person in Charge of emirs i<4 /�i,4..)> t! Z +please print) W Signature Title Df��,'Y0--f 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#