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Manell, Carolyn Ann - 0 F g Li q 0 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Carolyn Ann Manell Female Date of Death Age If Veteran of U.S.Armed Forces, 05/18/2023 57 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address 35 Haskell Avenue, Glens Falls, New York 12801 WW Manner of Death Undetermined Pendin Natural Cause ❑Accident Homicide Suicide g W Circumstances Investigation W Medical Certifier Name Title Q Sean Campanie NP Address 9 Carey Road,Queensbury Town, New York 12804 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 262 Burial Date Cemetery,Crematory or Facility Name 05/23/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town, New York Donation o❑Removal Date Place Removed and/or and/or Held H N Hold Address O Q- Date Point of CO 0Transportation 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 i Address CC W a" Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/23/2023 Registrar of Vital Statistics Megan Wolin(Electronically 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 �� W Date of Disposition s(Z4 I'h, Place of Disposition "��`2af7k1dressJ W U) cc (section) /11 /iot number/ /grave number/ OName of Sexton or Person in Charge ofPre ' es ^ L I N' Z Tease print) W Signature Title `�` ' - g 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#