Horning, Peter NEW YORK STATE DEPARTMENT OF HEALTH'
Vital Records Section - 3 Burial - Transit Permit
Name First Middle Last Sex
Peter Alex Horning Male
Date of Death Age If Veteran of U.S. Armed Forces,
I- April 4, 2006 55 War or Dates Vietnam
2 Place of Death Hospital, Institution or
W City, Town, or Village Glens Falls Street AddressGlens Falls Hospital
G Manner of Death x❑ Natural Cause ❑ Accident n Homicide Suicide ❑ Undetermined ❑ Pending
W Circumstances Investigation
(,y Medical Certifier Name Title
W PAUL F BACHMAN MD
0 Address
Warrensburg Health Center, Warrensburg, NY 12885
WDeath Certificate Filed District Number Register Number
City, Town or Village Glens Falls . & 0 i i W
Date Cemetery or Crematory
❑ Burial April 6, 2006 Pine View Crematorium
Address
❑7C Cremation Ouaker Road Oueensburv, NY 12804-
Date Place Removed
4 ❑ Removal and/or Held
F and/or Address
Hold
0 Date Point of
0 ❑Transportation Shipment
d by Common Destination
0 Carrier
Date Cemetery Address
a ❑ Disinterment
❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00284
Address
F 68 Main St., P. 0. Box 67, Hudson Falls, New York 12839
Name of Funeral Firm Making Disposition or to Whom
ce Remains are Shipped, If Other than Above
w Address
O.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 44 I5/06 Registrar of Vital Statistics 1 11 ,cct... . /(A#' `,
(signature)
District Number 5 6 b f Place Glens Falls,New York
F I certify that the remains of the decedent identified above were disposed of in accordance with
�1 this permit
permit on:
`� DispositiorA� /�/ m-�e-id c' - /`f u
w Date of Disposition Lo-d� Place of
2 (address)
w
f)
IC (section) (lot number) (grave number)
0
O Name of Sexton or Person in Charge of Premises C.)LNA,-1 �q Cr-,y� 1 `--
w (please print)
Signature 66QA� ��.t� -_ Title ((J., ekrI %A.-0