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Howard, Margaret Ruth g Li 41!!!) NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Margaret Ruth Howard Female Date of Death Age If Veteran of U.S.Armed Forces, 10/29/2023 58 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Mount Pleasant Town Street Address Westchester Medical Center p Manner of Death ❑X Natural Cause Accident ❑Homicide Suicide Undetermined riPending W Circumstances Investigation W Medical Certifier Name Title CI Menasche Krupka MD Address 100 Woods Road,Mount Pleasant Town,New York 10595 Death Certificate Filed Town Of Mount Pleasant District Number Register Number City,Town or Village 5957 794 Burial Date Cemetery,Crematory or Facility Name ® 11/03/2023 Pine View Crematorium _Entombment Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held F- Hold Address 0 O. Date Point of N Transportation p by Common Shipment Carrier Destination Date Cemetery Address Disinterment 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 W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/31/2023 Registrar of Vital Statistics Emir);Costanza(ECectronicaCCySigned) (signature) District Number 5957 Place Town Of Mount Pleasant I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 1/i 2pZ3 Place of Disposition ',.e (`�� CrP�H)s1I•t- (address) W CC CC (section) (IQtnumber) (grave number) 0 Name of Sexton or Person in Charge Premises �)�/��� wDC� Z (please print) IL / • Signature Title r>0C-4.1 '`— DOH-1555(07/18)p t of 2 o., L 7 e.r �F 3 4, Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on,bhrial,permit Official Funeral Directors Reg. or License#