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Smith, Inez M
L )„.. tr zip NEW YORK STATE DEPARTMENT OF HEALTH _ Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Inez M.Smith Female Date of Death Age If Veteran of U.S.Armed Forces, 02/22/2024 74 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital W Manner of Death Undetermined Pending W Natural Cause Accident Homicide Suicide Circumstances Investigation W Medical Certifier Name Title G Timothy Reed MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed City Of Saratoga Springs District Number Register Number City,Town or Village 4501 126 Burial Date Cemetery,Crematory or Facility Name 02/27/2024 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 a. Date Point of CO)OTransportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address IIIReinterment 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 CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/27/2024 Registrar of Vital Statistics 'Dillon IMoran(E(ectronica((y Signed) (signature) District Number 4501 Place City Of Saratoga Springs I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Date of Disposition 2176(14 Place of Disposition 77.�,v ) (0 m�4T�'4-+� 2 (address) W CO (section) 4., (lot number) (grave number) g Name of Sexton or Person in Charge of Prem. L ti z (tease print) W Signature Title tiVA r DOH-1555(07/18)p 1 of 2 - - 1-1 8 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#