Danahy, Rian NEW YORK STATE DEPARTMENT OF HEALTH
Vitt4Records Section Burial - Transit Permit
14
Name First Middle Last Sex
Rian A. Danahy Male
Date of Death Age If Veteran of U.S. Armed Forces,
December 7, 2011 40 War or Dates
!-: Place of Death Hospital, Institution or
W` City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death[] Natural Cause O Accident O Homicide O Suicide O Undetermined 1-1 O Pending
Circumstances Investigation
Ulf Medical Certifier Name Title
a Timothy Murphy,
Address
52 Haviland Ave Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village S�O/� 5 3 -7
a..-®Burial Date Cemetery or Crematory
December 12, 2011 Pine View Cemetery
0 Entombment Address
OCremation Quaker Rd. Queensbury,NY 12804
Date Place Removed
Z O Removal and/or Held
and/or Address
.: Hold Pine View Cemetery
Date Point of
o O Transportation Shipment
by Common Destination
a Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
F-; Remains are Shipped, If Other than Above
2• Address
U
0..° Permission is hereby granted to dispose of the human remains desc ' o as ':sited.
Date Issued / /00// Registrar of Vital Statistics
/
(signature)
District Number J�0 _,4/ Place � ,Yl7 AY
IL I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
j Date of Disposition 1 2/1 2/1 1 Place of Disposition Pine View Cemetery
(address)
WTh Erie 55D 1
(section) (lot number) (grave number)
la Name of Sexton or Perso in Charge of Premises Michael Genier
(please print)
141 Signature Title Superintendent
(over)
DOH-1555 (02/2004)