Manney, Henry NEW YORK STATS DEtRTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
~. Name First Middle Last Sex
Henry Louis Manney Male
Date of Death Age If Veteran of U.S. Armed Forces,
March 10, 2011 68 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death El Natural Cause n Accident El Homicide Suicide ElUndetermined ri Pending
Circumstances Investigation
Medical Certifier Name Title
Craig A Emblidge MD,
Address
s,i' 3 Irongate Center Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village 5601 Y 2 /
®Burial Date Cemetery or Crematory
7= �" March 15, 2011 Pine View Cemetery
❑Entombment Address
DCremation Quaker Rd. Queensbury,NY 12804
•
Date Place Removed
',El Removal and/or Held
and/or Address
Hold Pine View Cemetery
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
,,,, Reinterment Date Cemetery Address
Permit Issued to Registration Number
-; Name of Funeral Home Carleton Funeral Home, Inc. 00276
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
x 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 human remains described aboye as indicated.
Date Issued 3 / 111 i ! , Registrar of Vital Statistics OA j)- Z \4"
(signature)
District Number 5601 Place 6 ��^-S \1 S , Ao
5
Ntfii I certify that the remains of the decedent identified above were disposed of in accordance with this permit or:
Date of Disposition 3/15/11 Place of Disposition Pine View Cemetery
(address)
sx Huron 2B 1
x (section) (lot number) (grave number)
Michael Genier
". Name of Sexton or Person in Charge of Premises (please print)
iV - ,..iiiiNvA
ut, Superintendent
Signature Title
(over)
DOH-1555 (02/2004)