Tubbs, Nathan NEW YDRK STATE DEPARTMENT DFHEALTH ��N8�^��8 ~ 7��������~� D�^����^�
Vital Records Section
�~~~~ ^~~^ Transit Permit
Name First Middle Last Sex
Nathan S. _--...-_---... -_----m ale. --
Date of Death Age If Veteran of U.S.Armed Forces,
War nrDates
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..... Place of Death Hospital, Institution or
CbyTnwnoryl|lage City of Glens Falls Street Address Glens Falls Hospital
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��n*rm�� � N��|<�� �� ,�ido� � Hom�� � Su�a � �� �
� �� u u u Ci�m�ammx�� Investigation
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Medical Certifier Name Title
AndrewG _ .........................
---
88 Broad _______�
...... Death Certificate Filed District Number Register Number
City,Town or Village City of Glens Falls
r» DateCeme��orCmma��
���Buha| November 2, l3S2 Pine View Cemetery
[�Cmm�o °wv/�m
�� '' Queenabury, New York
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2 [lRemoval
and/or
an��rHe�
and/or ������ ---- — ------------------------------'------------
------------- -----'---Point of-------------------------------------
0� Date
Ln []Tnansportationby Shipment
C1 Common Carrier.............................................. Destination
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Address
� Fl Dioimanner8 --' '
.........................------------- ...........
Address
\ ElRaintonnent --- Cemetery
� Permit Issued to Registration Number
Name of Funeral Firm
Address
26 Quaker Road, Queensbury, New York 12804
Name of Funeral Firm Making Disposition or to Whom
.2:1 Remains are Shipped, If Other than Above
Address
....... Permission is hereby granted to dispose of the hu reT I s described above as indicated.
Date Issued Registrar of Vital Statisti s
District Number Place \J.
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date o[Disposition //�"� -�A Place cf Disposition *yI/c-- �> ' ~�� )// � '4'L-T�AIS 6���'/ «}�
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(e /9x)
(section) (lot number) (grave number)
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0 Name ofSextpa-. rPemoninCh�gonfPmmiooa C»r� �r
o: ' (please print)
WSignature
Th|o
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