Sleight, Raymond NEW YORK STATE DEPARTMENT OF HEALTH sw Burial - Transit Permit
''Vital Records Section ,.�.�.■.
Name First Middle Last Sex
e Raymond H. Sleight Male
Date of Death Age If Veteran of U.S. Armed Forces,
09/27/2011 77 War or.Dates N/A
i : Place of Death Hospital, Institution or
w. City, T it of a Plattsburgh Street Address CVPH Medical Center
p Manner of Death 1401
Natural Cause Accident 0 Homicide 0 Suicide �Undetermined 0 Pending
tL Circumstances Investigation
w Medical Certifier e Name Title
0 Todd Whitman M.D.
Address
75 Beekman Street, Plattsburgh, NY 12901
Death Certificate Filed District Number Register Number
City, XemiricisMinajt Plattsburgh 901
Hic.caBurial Date Cemetery or Crematory
['Entombment 10-03-2011 Pine View CPmetpry
Address
['Cremation Queenabury, NY 128 4
Date Place Removed
Z El Removal and/or Held
and/orI. Address
. Hold
N
O Date Point of
cEi Transportation Shipment _
a by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home REgan & Denny 01 443
>> Address
53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
l-.. Remains are Shipped, If Other than Above
2 Address
W
9' Permission is her by granted to dispose of the human re sins described above as indi ated. 2---
,/,,,,..._,....I uedq zz Re istrar of Vital Statistics � C/Date ss Vd g7-
__....
(signature)
District Number 901 Place City Of P attsburgh
'. " I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
Z Pine View Cemetery
tit g Date of Disposition 1 0/3/1 1 Place of Disposition
(address)
Ill
to Horicon 5F 1
CC, (section) (lot number) (grave number)
p Michael Genier
p Name of Sexton or Perso Charge of Premises —
t (please print)
Wr Title Superintendent
Signature
(over)
DOH-1555 (02/2004)