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Appling, Gracie S , i LF \ g- -)L(Li NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Gracie S Appling Female Date of Death Age If Veteran of U.S.Armed Forces, 09/09/2023 89 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Greenwich Town Street Address 242 Kilburn Road,Greenwich Town,New York 12834 IJJ p Manner of Death El NaturalCause EAccident Homicide Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title O Karen Going NP . Address 325 Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed Town Of Greenwich District Number Register Number Ci ,Town or Village 5757 15 Burial Date Cemetery,Crematory or Facility Name 09/14/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York ▪Donation OZ❑Removal Date Place Removed and/or and/or Held H Hold Address to 0 d Date Point of Cl) Transportation S by Common Shipment Carrier Destination ODisinterment 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 1— Remains are Shipped,If Other than Above 1E Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/14/2023 Registrar of Vital Statistics Deborah Tarks(ECectronicalTy Signed) (signature/ District Number 5757 Place Town Of Greenwich I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Place of Disposition Z q U.1 Date of Disposition I l�r i�� 'P•. � __ ,2 (address) W Cl)CC (section) 4(lot number) (grave number) 8 Name of Sexton or Person in Charge of Pr rt f ii Z y / /p e e print) W Signature / Title CH�W � DOH-1555(07/18)p 1 of 2 au 2 Public Health Law Sec. 4145(2b) : . .. x"r;.y Receipt Human remains of'.y,),, delivered on , 20 .ti Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#