Huntington, Aubrey NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Aubrey David Huntington Male
Date of DeathAge If Veteran of U.S. Armed Forces,
P 11/2 /20:12 65 year War or Dates 1-967 1970
144 Hospital, Institution or
eatn
Street Address
� Cit o�j�,�XVqtX Clcns F� Rark JCn a�lls N 1 1
�bFanner o'tSeatNatural Cause Accident ❑Homicide ❑Suicide tf&r e ermined Pending
Circumstances Investigation
U Medical Certifier Name Title
0
Add ess i A Caiotti grubbs M D
102 Park St Glens Falls, N Y 12801
Death Certificate Filed District Number Register Number
City, Tov 5trXV XX Clcns Folic 5601 541 •
<::;: � urial a e Cemetery or Crematory
:a['Entombment Address 1/28/2012 St Alphonsus Cemetery
❑Cremation •
ucellsbuiy,-N Y
Date Place Removed
_•,,,,kZ❑Removal and/or Held
wrr and/or Address
w= Hold
O Date Point of
ti❑Transportation Shipment
G by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard n Raker Funeral Hnme 01130
Address
11 Lafayette Street Qiieensbiiry, N Y 12804
Name of Funeral Firm Making Disposition or to Whom
I Remains are Shipped, If Other than Above
J .
• Address
i
Permission is hereby granted to dispose of the human re ains described ab ve as indic ed. i
MI i Date Issued Registrar of Vital Statistics '� -- 1
���7F�7n17 g _yam_ �I _ _ ��---'.__�� - -
(signature) •
District Number Place N�/ �� �
5601 Glens Falls /
a.::; I certify that the remains of the decedent identified above were isposed of in accordance with this permit on:
7�1 i
. Ui• Date of Disposition I(\ Z O 1 I Z Place of Disposition Sj 0 1iV dr�S,j, ,1,"� .Ve NS (k
i 1 address)
iii
to 1:112 Paz t
cc (se ) ( t n tuber) (grave number)
aName of Sexton or.Person in Charge of Premises CI '-''
(ple se print)
ill fp ----------------
Signature Title 1^4C1C10 e___f
(over)
DOH-1555 (02/2004)