Hoyas, Eugene NEW YORK STATE DEPARTMENT OF HEALTH \ "
Vital Records Section Burial - Transit Permit
Iiiiiii Name First Middle Last Sex
Eugene K. Hoyas Male
iiig Date of Death Age If Veteran of U.S. Armed Forces,
iN 3/16/2006 79 War or Dates 1953-1955
iN
14 Place of Death Hospital, Institution or
City, Vivitr-PSAMEA4x Glens Falls Street Address Glens Falls Hospital
Manner of Death 0 Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
FA Circumstances Investigation
Medical Certifier Name Title
John Sawyer M. D.
Address
QtAeellshu yr 'Y
111 Death Certificate Filed District Number Register Number
iiiiIi0 City, Tdr ilia Glens Falls 5601
Date Cemetery or Crematory
>: ❑Burial 3/20/2006 Pine View Crematory
Address
❑Cremation Queens'ouryr NY
FDate Place Removed
2❑Removal and/or Held
i.. and/or Address
THold
6 Date Point of
fiti❑Transportation Shipment
fl by Common Destination
Carrier
•
ii:i ❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Brewer Funeral Homer Inc . 00211
Address
24 Church St . , Lake Luzerne , NY 12816
Name of Funeral Firm Making Disposition or to Whom
"' Remains are Shipped, If Other than Above
AP Address
re
a
iiiiiiii; Permission is hereby granted to dispose of the human remains de cri ed abo as' c ted.
iig Date Issued 3/20/2006 Registrar of Vital Statistics ///�i//l
(signature)
gi District Number 5601 Place City of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
• iF
w Date of Disposition 3.-2/-0(, Place of Disposition 10/Ne L%I) C i?r 4 A U�- ) 1J
a (address)
LI'J
U3
CC (section) ilot number) (grave number)
Name of Sexton or Person in Charge of Premises Cs,- . rk- iZ14.) 8, A-
Z
- (please print)
t . Signature Cp (`��94a/6(--- Title CC -F,n -ficitZ
(over)
DOH-1555 (9/98)