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Prevost, Frances Sally 6Sb NEW YORKSTATE DEPARTMENT OF HEALTH -- Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Frances Sally Prevost Female Date of Death Age If Veteran of U.S.Armed Forces, 08/12/2023 79 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Schenectady Street Address Ellis Hospital p Manner of Death 1:1 Natural Cause Accident Homicide ESuicide Undetermined riPending W C.) Circumstances Investigation WD Medical Certifier Name Title Kynl Choumarov MD Address 1101 Nott St,Schenectady,New York 12308 Death Certificate Filed City Of Schenectady District Number Register Number City,Town or Village 4601 642 Burial Date Cemetery,Crematory or Facility Name 08/16/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation 0 Removal Date Place Removed and/or and/or Held F Hold Address 0 d Date Point of U) Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address EIReinterment 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 1— Remains are Shipped,If Other than Above M Address Cr W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/16/2023 Registrar of Vital Statistics Samanta 12 Mykoo(ECectronicalTy Signed) (signature) District Number 4601 Place City Of Schenectady I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition gln Place of Disposition ?`,tt— W (address) LU CC N (section) /J (lot number) (grave number) `/n/ Name of Sexton or Person in Charge of Premises roe e--- s t f Z / tease print/ W Signature Title 6 N DOH-1555(07/18)p 1 of 2 • e, Li I 7 20 4 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#