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White, Catherine Theresa Ann .. .10F 1:11 . NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Per it Bureau of Vital Records Name First Middle Last Sex Catherine Theresa Ann White Female Date of Death Age If Veteran of U.S.Armed Forces, 01/19/2024 80 Years War or Dates H Place of Death Hospital,Institution or ti WCity,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death E Natural Cause Accident ❑Homicide nSuicide Undetermined ❑Pending UCircumstances Investigation W Medical Certifier Name Title a Christopher Smith 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 37 Burial Date Cemetery,Crematory or Facility Name 01/22/2024 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York ❑Donation ZZ❑Removal Date Place Removed and/or and/or Held —. Hold Address 0 CL Date Point of t/)❑Transportation CI Common Shipment 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 H Remains are Shipped,If Other than Above 2 Address Q W 0" Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/22/2024 Registrar of Vital Statistics Megan.No('n(Efectronicaffy 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- Z Date of Disposition [ 113174 Place of Disposition FIVF« Ckb+n4>tit, IJJ 2 (address) W U) Q (section) numberlit (grave number) g Name of Sexton or Person in Char ff remises41:14 (lot � Z (p ase print) W at Signature Title ^ l DOH-1555(07/18)p 1 of 2 0�° 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#