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Lopez, Monica Munoz ' 4111) NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Monica Munoz Lopez Female Date of Death Age If Veteran of U.S.Armed Forces, 07/03/2023 40 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death Natural Cause Accident El Homicide Suicide Undetermined ri Pending W C.) Circumstances Investigation W Medical Certifier Name Title Timothy Murphy Coroner Address 52 Haviland Avenue,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 329 H Burial Date Cemetery,Crematory or Facility Name 07/06/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation OZ❑Removal Date Place Removed and/or and/or Held ~ Hold Address V) 0 d Date Point of N❑Transportation Shipment p by Common Carrier Destination Date Cemetery Address Disinterment Reinterment Date Cemetery Address Permit Issued to Registration Nun �r 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 1— Remains are Shipped,If Other than Above Address CC W a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/06/2023 Registrar of Vital Statistics Megan NoCn(ElectronicalySigned) (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: ZW Date of Disposition 7 ZO23 Place of Disposition e, e 2 (address W N CC (section) (11 number) (grave number) gName of Sexton or Person in Charge Pre is r1"y'mo./D ht a� Z (please print) W G g �Signature . Title DP� e5' s ti 4 DOH-1555(01/18)p i of 2 r : 7O coo"8 Public Health Law Sec. 4145(2b) Receipt e i Human remains of delivered on '• , 20 Pine View Cemetery Representing the funeral home named 911,13154!permit Official Funeral Directors Reg.or License#