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Carroll, Carol Anne
NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records �__ Burial - Transit Permit Name First Middleir Last Sex Carol Anne Carroll Female Date of Death Age If Veteran of U.S.Armed Forces, 01/11/2024 83 Years War or Dates i_ Place of Death Hospital,Institution or pZ City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare Manner of Death � W Natural Cause Accident Homicide ESuicide Undetermined ❑Pending U Circumstances Investigation WQ Medical Certifier Name Title Brandii Baker NP Address 4573 State Route 40,Argyle Town,New York 12809 Death Certificate Filed Town Of Argyle District Number Register Number City,Town or Village 5750 5 Burial Date Cemetery,Crematory or Facility Name 01/13/2024 Pine view crematory Entombment Address ©Cremation Queensbury Town,New York Donation 6❑Removal Date Place Removed H and/or and/or Held N Hold Address 0 a Date Point of C/)❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward, New York 12828 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above g Address CC W a- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/12/2024 Registrar of Vital Statistics Shelley Mckernon(EfectronicaCCySigned) (signature) District Number 5750 Place Town Of Argyle I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Date W Date of Disposition / 3?DZy Place of Disposition V 1 foe V 49� C ,,e e , 40 r >r 2 (address) W N CC (section) (lot number) (grave number) Name of Sexton or Person in Charge of Pr ises y{ 4.1J.D 11)61, W - I�_ (please print) Signaturee. .. ...: -, .,'> Title eeefv`r DOH-1555(07/18)p 1 of 2 6�� t • `� 1 7 t? 6,7 '1 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on bpriallpermit Official Funeral Directors Reg.or License#