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Coons, Lena May Underwood Chambers
r ��I , ay. r. NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Lena May Underwood Chambers Coons Female Date of Death Age If Veteran of U.S.Armed Forces, 11/16/2023 94 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death Natural Cause IllAccident Homicide Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title G Julian Marynczak PA 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 534 Burial Date Cemetery,Crematory or Facility Name 11/18/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation OZ❑Removal Date Place Removed and/or and/or Held H Hold Address CO 0 O. Date Point of U) Transportation p 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 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 11/17/2023 Registrar of Vital Statistics Megan Wolin(ECectronicalty 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: I— � W Date of Disposition /��g Z013 Place of Disposition V ' , vet> (re- i. -L 2 (address) W CC t!) (section)., (lot number) (grave number) SName of Sexton or Person in Char of Pre ses eQyl�nt Z ` Q // / (please print) W Signature X. .V Title Dr-C'4_ 1— DOH-1555(07/18)p 1 of 2 .I'}'•Y ry ry k "7 'e 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#