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Parker, Carol Ann # L,,1 LF NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Carol Ann Parker Female Date of Death Age If Veteran of U.S.Armed Forces, 06/02/2023 86 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc UJ p Manner of Death El Natural Cause Accident Homicide Suicide Undetermined El Pending W Circumstances Investigation U W Medical Certifier Name Title CI Carrie Miron PA Address 319 Broadway Fort Edward Town,New York 12828 Death Certif,cate Filed Town Of Fort Edward District Number Register Number `` City,Town or Village 5755 51 Burial Date Cemetery,Crematory or Facility Name 06/02/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held H Hold Address to 0 d Date Point of N OTransportation Shipment Q by Common 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 H Remains are Shipped,If Other than Above 5 Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/02/2023 Registrar of Vital Statistics Aimee G 9tlaloney(ECectronica[Cy Signed) (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: z ���-- W Date of Disposition (�h 173 Place of Disposition 2 (address) IL N CC (section) � (lot number) (grave number) gName of Sexton or Person in Charge of Premises ^ l— ' (please print)W /Signature Title '�p7�� DOH-1555(07/18)p l of 2 x 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#