Crawford, Donald NEW YORK STATE DEPARTMENT OF HEALTH
'v'Ital Records Section Burial - Transit Permit
} Name First Middle Last Sex
Donald Harry Crawford Male
Date of Death Age If Veteran of U.S. Armed Forces,
I- August 28, 2006 84 War or Dates World War II
2 Place of Death Hospital, Institution or '
W City, Town, or Village Glens Falls Street AddressGlens Falls Hospital
(1 Manner of Death 0 Natural Cause El Accident n Homicide OSuicide 0 Undetermined El Pending
W Circumstances Investigation
Medical Certifier Name Title
W DONALD R SHEELEY MD
Q Address
100 Park St., Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5 0 ) W 17
Date Cemetery or Crematory
El Burial _ September 1, 2006 SCOTCH CEMETERY
Address � 1�
� ❑Cremation � ue�-GCS Gw , N--j Jgid -(
Date Place Removed
0 0 Removal and/or Held
r and/or Address
r. Hold
Date Point of
0 n Transportation Shipment
d by Common Destination
A Carrier
Date Cemetery Address
0 El Disinterment
Reinterment Date Cemetery Address
Permit Issued to ' Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00283
Address
68 Main St., P. O. Box 67, Hudson Falls, New York 12839
Name of Funeral Firm Making Disposition or to Whom
X Remains are Shipped, If Other than Above
w Address
O.
Permission is hereby granted to dispose of the human remains descri ede indi d
Date Issued 5! 3 Q ) UV Registrar of Vital Statistics
(signature)
District Number 5j 60 l Place Glens Falls,New York
h I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 9/1/06 Place of DispositionSCOTCH CEMETERY,QUEENSBURY NY
W (address)
th FAMILY PLOT
p (section) (lot number) (grave number)
? Name of Sexton or Person in Charge of Premises M I CHAEL GEN I ER
W (please print)
Signature Title SUPT.