Noonan, Byron NEW YORK STATE DEPARTMENT OF HEALTH 1 S O
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Byron G. Noonan Male
Date of Death Age If Veteran of U.S.Armed Forces,
F December 17, 2006 War or Dates
Z Place of Death Hospital, Institution or
W City,Town, or Village Glens Falls Street Address Glens Falls Hospital
0 Manner of Death 0 Natural Cause ❑ Accident ❑Homicide ❑Suicide ❑Undetermined ❑ Pending
W Circumstances Investigation
0 Medical Certifier Name Title
W John Rugge MD
0 Address
102 Park Street, Glens Falls, New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 6'60/ 3 y
n Burial Date Cemetery or Crematory
12/19/2006 Pineview Crematorium
❑Entombment Address
x❑Cremation Queensbury, New York
Date Place Removed
0 ❑ Removal and/or Held
- and/or Address
I' Hold
0 Date Point of
0 ❑Transportation Shipment
d by Common Destination
m Carrier
Date Cemetery Address
0 El
Disinterment
El
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home, Inc. 00931
Address
46 Williams Street, Whitehall, New York 12887
H Name of Funeral Firm Making Disposition or to Whom
2 Remains are Shipped, If Other than Above
IX
W Address
0.
Permission is hereby g anted to dispose of the human remains de cribe abo as c ed.t
Date Issued L f_ 6. Registrar of Vital Statistics �al,
(signature)
District Number .S O/ 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:
Z
W Date of Disposition la/q /6 , Place of Disposition pi,a,,„,,,,;,, Cfr-4,--:ror r ---.-
2 (address)
W
0
IC (section) (lot number) (grave number)
0 Name of Sexton o.Person in harge of Premises (I.r'S S,P n rj or
Z 1 (please print)
Ili
Signature 'lilto Title C(seirng.kcr
(over)
DOH-1555 (02/2004)