Mitchell, Carol NEW YORK STATE DEPARTMENT OF HEALTH g Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Carol E.Mitchell Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/22/2023 88 Years War or Dates
H Place of Death Hospital,Institution or
'Z City,Town or Village Moreau Town Street Address 1696 State Route 9,Moreau Town,New York 12803
p Manner of Death El Natural Cause Accident Homicide El Suicide Undetermined riPending
IIJ Circumstances Investigation
W Medical Certifier Name Title
0 Paul Filion MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed Town Of Moreau District Number Register Number
City,Town or Village 4562 66
X Burial Date Cemetery,Crematory or Facility Name
11/28/2023 Pine View Cemetery
Entombment
_ Address
Cremation Queensbury Town,New York
Donation
Zo Removal Date Place Removed
and/or and/or Held
— Hold Address
Date Point of
N OTransportation Shipment
3 by Common
Carrier Destination
Disinterment
Date Cemetery Address
Ei
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
., Remains are Shipped,If Other than Above
g Address
IX
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/27/2023 Registrar of Vital Statistics Brenda Mutter(E(ectronica1TySigned)
(signature)
District Number 4562 Place Town Of Moreau
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H /
WDate of Disposition \,,,DP),� Place of Disposition �j �C t4��� � �L/E'er'77S�L)r� /�/y ia�(
2 (address)
4°
ill AirifJ
i ) A a
EC section ( number/ (grave number)
gName of Sexton or Person in Charge of Prem. s C - -��z ri I \ l2 `-c� `^"
z (please print)/
W Signature /� 4.
Title �� 2 / n cl� t
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
1
Human remains of delivered on , 20
'ne View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
MITCHELL
411) Lot No. 10-0
ddress 4403 Rt . 50 , Saratoga Springs , NY 12866 Section No.
Iwner Bradley & Carol Mitchell Plot Abenaki
ate 11/26/99
Approx . 67 Superficial ft. @
ocation Bounded on North by Vacant , South by Vacant , East by Vacant ,
West by Vacant .
orner Posts
emarks
eed No. (and changes 9 9 5
ayment Record Paid in Full 11/26/99 ($700 . 00)
ecord of Interments
ap
alicrA A-61e_1i 1\ 43,o 1►. aa.a3 V V �✓
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mu No. 01
MITCHELL
NAME Carol MitchellF
Age: $$
Lot Owner: Bradley & Carol Mitchell
Lot# Abenaki 10 G Grave# 2
Case: Concrete
Died: 11 .2 2.2 3 Interred: 1 1 .2 8.2 3
Funeral Home: Regan Denny Stafford
Cemetery: Pine View