Kilmartin Sr, Raymond L
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
8 Name First Middle Last Sex
Raymond Harris Kilmartin Sr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
F September 15. 2006 70 War or Dates
2 Place of Death Hospital, Institution or
W City, Town, or Village Glens Falls Street AddressGlens Falls Hospital
0 Manner of Death x❑ Natural Cause ❑ Accident ❑ Homicide Suicide ❑ Undetermined ❑ Pending
W Circumstances Investigation
U Medical Certifier Name Title
W FARHANA KAMAL MD
10 Address
Glens Falls Hospital, Glens Falls, NY 12801
Death Certificate Filed District Number Register NU ber
c} , City, Town or Village Glens Falls 6
Date Cemetery or Crematory
❑ Burial September 19. 2006 Pine View Crematorium
Address
0 Cremation ouaker RoadZ Oueeasburv, NY 12804-
Date Place Removed
0 ❑ Removal and/or Held
- and/or Address
- Hold
Date Point of
0 ❑Transportation Shipment
d by Common Destination
0 Carrier
a ❑ Disinterment
Date Cemetery Address
❑ Renterment 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
ix Remains are Shipped, If Other than Above
w Address
O.
Permission is hereby granted to dispose of the human remains describe a ov ydicaDate Issued 9 1J �1 I&6 Registrar of Vital Statistics '
(signature)
District Number5j Place Glens Falls,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 Cl /aa/G(, Place of Disposition pine.n.cw C. nw.4-,,,; ,,,�
W (address)
v)
Z0 (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises CI) rt S S ty,„cor
W (please print) /�
Signature ��j,u„ 4„�5..._ C.Title rw;+vt