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Hotte, Cecilia Jo NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records ' Name First Middle Last Sex Cecilia Jo Hotte Female Date of Death Age If Veteran of U.S.Armed Forces, 06/25/2023 61 Years War or Dates F Place of Death Hospital,Institution or 111 Z City,Town or Village Moreau Town Street Address 116 Bluebird Terrace Lot 1,Moreau Town,New York 12828 p Manner of Death El Natural Cause Accident 0 Homicide Suicide Undetermined ri Pending W V Circumstances Investigation Ill G Medical Certifier Name Title Aimee Mcmaster NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Moreau District Number Register Number City,Town or Village 4562 31 BurialId Date Cemetery,Crematory or Facility Name 06/27/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation Z❑Removal0 Date Place Removed H and/or and/or Held N Hold Address 0 d Date Point of Cl)❑Transportation ES Common Shipment Carrier Destination ElDisinterment Date Cemetery Address ElReinterment 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 , _ _■w me of uneral ' , Making Dispositiono[2QWhom 1— Remains are Shipped,If Other than Above 2 Address cr W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/27/2023 Registrar of Vital Statistics Brenda 2futter(ECectronicaCCy Signed) (signature) District Number 4562 Place Town Of Moreau I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Ui Z Date of Disposition 1 f'7I I Z3 Place of Disposition 2 (ad ress) W U) CC (section) I/lot number) (grave number) S Name of Sexton or Person in Charge of Pr ' 4 `_�a,N,\ Z (pie se print) W Signature Title � ��(�� DOH-1555(07/18)p 1 of 2 . . r) Public Health Law Sec. 4145(2b) 1 Receipt 1 1 , , . 7 1 Human remains of delivered on , 20 1 1 4 r 1 , 1 r 1 1 Pine View Cemetery Representing the funeral home named on Wm)vermit 1 Official Funeral Directors Reg.or License# 1 i 1