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Perry-Prosser, Lois
),/;\t(1) NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Lois Prosser-Perry Female Date of Death Age If Veteran of U.S.Armed Forces, 01/19/2024 57 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death Undetermined Pendin W Natural Cause Accident Homicide Suicide g Circumstances Investigation W Medical Certifier Name Title G Shahid Ahmed MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Numher City,Town or Village 5601 48 Burial Date Cemetery,Crematory or Facility Name 02/03/2024 Pine View Crematorium _Entombment Address ©Cremation Queensbury Town,New York Donation ClRemoval Date Place Removed and/or and/or Held H Hold Address N 0 O. Date Point of (/) Transportation p by Common Shipment Carrier Destination ElDisinterment 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 5 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/24/2024 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: Z Date of Disposition 21 S I 21 Place of Disposition r:_cN6(irE J Cr*tvorti0/ 2 (address) W (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises /� h �.,./ Z (pie a print) W Signature Title fa DOH-1555(07/18)p 1 of 2 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#