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Durkee, Jane Marie
it 17 6 • NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Jane Marie Durkee Female Date of Death Age If Veteran of U.S.Armed Forces, 02/02/2024 88 Years War or Dates i_ Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc p Manner of Death El Natural Cause EAccident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title CI Elizabeth Bessette NP Address 319 Broadway,Fort Edward Town,New York 12828 Death Certificate Filed Town Of Fort Edward District Number Register Number ,Town orVillage Cie 5755 15 Burial Date Cemetery,Crematory or Facility Name 02/06/2024 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York ▪Donation goRemoval Date Place Removed and/or and/or Held H Hold Address N 0 O. Date Point of U)ElTransportation p by Common Shipment Carrier Destination LI Disinterment Date Cemetery Address EIReinterment 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 E.. Remains are Shipped,If Other than Above 2 Address C W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/05/2024 Registrar of Vital Statistics Aimee L Mahoney(E(ectronica1y Signed) (signature) District Number 5755 Place Town Of Fort Edward I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition Z I 17H 3at Place of Disposition � e✓c f:-.J W.yr►47pai 2 (address) W NCC (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premises � lhi' L ! ft /� z (pt ase print) RISignature ( � Title ff i miriae- DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) •-J -- Receipt Human remains of delivered on _, 20 Pine View Cemetery kepresenting the funeral home named on burial permit Official Funeral Directors Reg. or License#