Guyett, Glen NEW YORK STATE DEPARTMENT OFHEALTH ��UN�~��� ~ ����l����^� ��^��8��^�
VhaRecords Sec�n �~�~~ ~°~~ ^ ~ ~~~~~~^° Permit
Name First Middle Last So
Glen Guyett _____________��Ie_________
Date of Death
Age If Veteran of
U.S
Jul �� l8S� yyurorDmum�' World War II
Place of Death Hospital, Institution or
City,Town o,Village City of Glens Fella Street Address Glens Falls Hospital
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ma »«un»»rmuean ��lN��uro|Cauoe �-� �ouiden� F-lHomio�a F-lG�icide �-lu»o*m»nmeo �-� om9
�-� �-u �-� �-� Circumstances Investigation
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MD Richard T. Ho ___________________ __________ _
Address
325 Mein Street, Hudson Falls, New York 12839
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Register Number
Death Certificate Filed
City of Glens Falls
City,Town or Village
Date Cemetery or Crematory
Burial Auaust 1. 1992 Pine View Cemetery
E]Cremation Address Queensbury, New York
z Date Place Removed
0 F1 Removal and/or Held
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OL Date
oo E]Toanuportakon by Shipment
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ElDioimennar� Cemetery Address
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El Rointennont --- Cemetery-- Address
Permit Issued to Registration Number
Name of Funeral Firm Regan and Denny Funeral Service, Inc. 01602
26 Quaker Road, Queensbury, N. Y. 12804
4;wl Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the hu Aescribed abov as indicated.
Registrar of Vital Statistic
Date Issued
Place
District Number .6
I certify that the remains of the decedent identified above were disposed of i ordance with this permit on:
Date ofDioLLj �u��n �� - �� Place
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cc � )' ress
number) (grave number)
Name
of Person in Charge of Premises
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LU Title
Signatur
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