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Carter, Carolyn S L1p-7 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Carolyn S Carter Female Date of Death Age If Veteran of U.S.Armed Forces, 05/09/2023 95 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Lake George Town Street Address 33 Kings Road,Lake George Town,New York 12845 Manner of Death j Natural Cause Accident Homicide Suicide Undetermined ❑Pending W C.) Circumstances Investigation WQ Medical Certifier Name Title Aimee Mcmaster NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Lake George District Number Register Number City,Town or Village 5651 3 Burial Date Cemetery,Crematory or Facility Name 05/10/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held N Hold Address 0 CL Date Point of (/)El Transportation by Common Shipment Carrier Destination EIDisinterment Date Cemetery Address Reinterment Date Cemetery Address 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 Ir Remains are Shipped,If Other than Above 2 Address Q W a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/10/2023 Registrar of Vital Statistics Patricia q,McKinney-Schuster(ECectronica1tySigned) (signature) District Number 5651 Place Town Of Lake George I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ~ � J W Date of Disposition VIZ I2.3 Place of Disposition t istj l,�-6,_, 2 (address) W CIC N (section) 71k 7 (lot number) (grave number) CIName of Sexton or Person in Charge of Premises fk b— �t Z (ease print/ IL Signature ? Title 41Wt' DOH-1555(07/18)p id 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#