Allen, Karen Ann NEW YORK STATE DEPARTMENT OF HEALTH - Buflat - Transit Permit
Bureau of Vital Records
Name First -Middle Last Sex
Karen.Ann Allen female
Date of Death Age If Veteran of U.S.Armed Forces,
12/12/2022 1-55 Years War or Dates
F. Place of Death 7Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital
p Manner of Death �Natural Cause Accident Homicide Suicide El UndeterminedEl
Pending
Circumstances Investigation
0 Medical Certifier Name Title
Hung Nguyen MID
Address .
211 Church-St,Saratoga Springs;New York 12866
Death Certificate Filed'"City Of Saratoga Springs District Number Register Number
City,.Town or Village- 4501 732
Burial Date Cemetery,Crematory or Facility Name
12/14/2022 Pine View Crematorium
Entombment ,Address
r—VICremation Queensbury Town,New York
Donation
ZO Removal Date Place Removed
and/or and/or Held
H Hold Address
N
O
a Date Point of
N Transportation
p by 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
Name of Funeral Firm Making Disposition or to Whom
I_ Remains are Shipped,If Otherthan Above
2 Address
Lu
CL Permission is-hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/14/2022 Registrar of Vital Statistics 1?iCCon Moran(Electronically Signed)
(signature)
Yi
District Number 4501 Place City Of Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance.with this permit on:
H -
Z ';Date of Disposition �2 zz Place of Disposition `,
Lu
2 ' (address)
W
N (sedion) (lot umber) (grave number)
Name of Sexton or Person in Charge Premi, e (�.J"
Z �/ (please print)
Lu Signature ` Title 6
DO H-1555(07/18)p 1 of 2
016500
Public Health Law Sec. 4145(2b) .
Receipt
Human remains of '=-> J delivered on , 20
Pine View Cemetery Representing the funeral home named on burialnermit
Official Funeral Directors Reg.or License# 1Y1