Reger Jr., George NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
George Frederick Reger Jr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
November 24, 2013 85 War or Dates
I Place of Death Hospital, Institution or
City, Town or Village Fort Edward Street Address Fort Hudson Nursing Center
CI Manner of Death m
Eti Natural Cause Accident �Homicide Suicide Undetermined Pending
W. Circumstances Investigation
W Medical Certifier Name Title
CI- Eileen Spinelli, NP
Address
9 Carey Rd Queensbury, NY 12804
Death Certificate Filed District Number Regis r mber
City, Town or Village 5 ).57.------- t
f ®Burial Date Cemetery or Crematory
❑Entombment Pine View Cemetery
Address
'0Cremation Quaker Rd. Queensbury,NY 12804
Date 1 Place Removed
Removal
z and/or j andTor Held
Hold Address
Pine View Cemetery
07 Date Point of
CL El Transportation Shipment
(I) by Common Destination
Lei Carrier
Disinterment Date Cemetery Address
0 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
Remains are Shipped, If Other than Above
2 Address
re
1.1J
11. Permission is reby ranted to dispose of the human ins describ ove s indicated.
Date Issued / Registrar of Vital Statisti
--`---- (signature)
District Number Place 7/
I certify that the remains of the decedent identified abo a ere disposed of in accordance with this permit on:
tDate of Disposition /i 60 /3 Place of Disposition /at. yi` 64,y_ej_t4.4 ht
(address)/
re: (section) (lot number) (grave number)
aName of Sexton or Person in Charge of Premises C-0 /1,G 1 (L'. L. 6 0G1 i-M2 c
(pie print)
W Signature _htAt-1 r L. - cC,c t Title C /A (1 .o14.44t(a,.d�ixf
��VJJ (over)
DOH-1555 (02/2004)
RPgAr Lot No.16F
Address 12 Willow Road Oueenshury, NY 1 7Rn4 Section No.
Owner PlotEr i e
-Jean Roger
VC)LA.yxciot_AM 01-1
•
Date Nov. 26, 2013
67 Superficial ft.
Location Bounded West Douros North Path, East Murphy, South Vacant
Corner Posts .
Remarks 518-793-2859
Deed No. (and changes) 3835
Payment Record tt2 n n
•
7-\.Nj .
Record of Interments
Uov'. 1Z0
1 -_--_.i
George Reger Nov. 30. 2Q13
2 �e"CifCRCSCi-. \ \Lo 0, 1 - ‘,:)- ',\-DD / YV
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Form No. 01
it A ME REGER, GEORGE •m_F)
Age: 85
Cause:Natural
Lot Owner: Jean Reger
Lot # 36 F Erie
Grave N 1
Case # Concete
Died: 1 1 /24/2013
Interred: 11 /30/201 3
Undertaker:
Carleton