Tabor, Bruce N.EWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
k Vital Records Section
. Name First Middle Last Sex
0 Bruce Michael Tabor Male
Date of Death Age If Veteran of U.S. Armed Forces,
F October 28, 2006 50 War or Dates
2 Place of Death Hospital, Institution or
W City, Town, or Village Corinth Street Address525 Main Street
G Manner of Death x❑ Natural Cause ❑ Accident ❑ Homicide ❑Suicide ❑ Undetermined ❑ Pending
W Circumstances Investigation,
U Medical Certifier Name Title
W CORONER J PASTON MD
Q Address
221 Church St. Saratoga Springs, NY
Death Certificate Filed District Number Register Number
City, Town or Village Corinth
Date Cemetery or Crematory
0 Burial November 3, 2006 MOUNT HERMON CEMETERY
Address
❑Cremation Oueensburv, NY
Date Place Removed
4 ❑ Removal and/or Held
I" Hold
Address
Hold
0 Date Point of
0 ❑Transportation Shipment
d by Common Destination
16 Carrier
Date Cemetery Address
a ❑ Disinterment
❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00283
Address
F 68 Main St., P. 0. Box 67, Hudson Falls, New York 12839
Name of Funeral Firm Making Disposition or to Whom
0:• Remains are Shipped, If Other than Above
w Address
0.
Permission is hereby granted to dispose of the human - ains de-cribed a ove a dicated.
Date Issued j/-0/"moo4' Registrar of Vital Statistic- ,0ieI•
signature)
District Number //S3 Place Corinth,New York
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition 11/3/0 6 Place of Disposition MT . HERMON GEM D U E E N S B U R Y NY
g (address)
9) FAMILY PLOT
0 (section) (lot number) (grave number)
O Name of Sexton or Person .n Charge of Premises M I C H A E L G E N I ER
2 (please print)
W Title S U P T .
Signature .t/��