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Griffin, Martha Louise (10 Q 5 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Martha Louise Griffin Female Date of Death Age If Veteran of lkS.Armed Forces, 10/17/2023 69 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W ititManner of Death Undetermined Pending Natural Cause Accident Homicide Suicide Circumstances Investigation WMedical Certifier Name Title 0 Shahid Ahmed MD • Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 487 Burial Date Cemetery,Crematory or Facility Name 10/19/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation ZO Removal Date Place Removed and/or and/or Held H Hold Address 0 O. Date Point of N nTransportation Shipment p by Common Carrier Destination Disinterment 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 F. Remains are Shipped,If Other than Above 2 Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/19/2023 Registrar of Vital Statistics Megan Nofin(EtectronicaCCy 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 Jo 120123 Place of Disposition (TAtFtiT FiiJ GD q ILI 2 (address) tn (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises "' !h Z / lease print) W Signature / Title (petal rim' DOH-1555(07/18)p id 2 CCC�J� 1 1 Public Health Law Sec. 4145(2b) 1 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#