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Fox, Sandra L
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Sandra L.Fox Female Date of Death Age If Veteran of U.S.Armed Forces, 09/19/2023 79 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death nUndetermined nPending�Natural Cause Accident El HomicideSuicide I I I 'Investigation Investigation W Medical Certifier Name Title Lynn Keil PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 445 Burial Date Cemetery,rCrematory or Facility Name 09/27/2023 Pine View Crematorium _Entombment Address ©Cremation Queensbury Town,New York Donation Z❑Removal Date Place Removed and/or and/or Held N Hold Address 0 Q. Date Point of (/) Transportation p by Common Shipment Carrier Destination Date Cemetery Address Disinterment El 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 �— 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 09/27/2023 Registrar of Vital Statistics Megan Noiin(ECectronicaliy Signed) (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: Z Date of Disposition IIZgl73 Place of Disposition `�1�_ 7 W ` (address) W (I) (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premis - " ease print) / Tty, Signature Title I ` �`v�`r DOH-1555(07/18)p t of 2 4.� a 017 320 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#