Hogge, Carole A irTriNEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Carole A.Hogge Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/17/2024 78 Years War or Dates
H Place of Death Hospital,Institution or
WCity,Town or Village Queensbury Town Street Address 44 Willowbrook Road 110,Queensbury Town,New York 12804
CI Manner of Death III Natural Cause IllAccident 0 Homicide ciSuicide Undetermined ❑Pending
LU
0 Circumstances Investigation
Ui Medical Certifier Name Title
CI
Anthony Petracca MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 10
Burial Date I Cemetery,Crematory or Facility Name
01/19/2024 I Pine View Crematory
Entombment Address — ----
RCremation Queensbury Town,New York
Donation
OZ❑Removal Date Place Removed
H and/or and/or Held
N Hold Address
0
d Date Point of
Cl)[]Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
[]Reinterment
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped,If Other than Above
Address
QC
W
0-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/18/2024 Registrar of Vital Statistics Carolinehrldegarde celarb-er
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
---W Date of Disposition AzC)..L e,1/Place of Disposition 1 i,y/� L. Cw) C!'efi�>s—k t`
2 (address)
W
Cl)
CC 7 (section) (lot n tuber) (grave number)
0 Name of Sexton or Person in Charge of premises J�� ,Jtft1G-�(� 1 �
Z -, / ✓ (please print)
W
Signature ��j.,4 I4 Title CV—C�4 c
DOH-1555(07/18)p 1 of 2 ff `,
Public Health Law Sec. 4145(2b) �� r
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#