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Simpson, Peggy Kay
if NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Peggy Kay Simpson Female Date of Death Age If Veteran of U.S.Armed Forces, 12/30/2023 91 Years War or Dates F. Place of Death Hospital,Institution or Z City,Town or Village Hudson Falls Village Street Address 32 Elm Street,Hudson Falls Village, New York 12839 W Manner of Death Undetermined Pending W Natural Cause Accident Homicide Suicide g Circumstances Investigation W Medical Certifier Name Title Hilary Jones NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Village Of Hudson Falls District Number Register Number City,Town or Village 5726 37 RBurial Date Cemetery,Crematory or Facility Name 01/02/2024 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York ElDonation OZ Removal Date Place Removed and/or and/or Held F—o Hold Address 0 d Date Point of N❑Transportation p by Common Shipment Carrier Destination 11 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 F Remains are Shipped,If Other than Above 5 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/02/2024 Registrar of Vital Statistics Cynthia Bardin(ECectronica1Ty Signed) /signature) District Number 5726 Place Village Of Hudson Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition !131 Z3 Place of Disposition, (1 i0�Qy41N� 2 (address) W CC CC (section) dityk.(lotnumber) (grave number) gName of Sexton or Person in Charge of Premises - :414 Ztease print) W Signature Title '' DOH-1555(07/18)p i of 2 .1 ' 7 0 -7 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#