Granger, Richard 2
'NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Richard Carlton Granger Male
Date of Death Age If Veteran of U.S. Armed Forces,
December 8, 2016 75 War or Dates
Place of Death Hospital, Institution or
w City, Town or Village Moreau Street Address 1659 Route 9, Lot 3
W! Manner of Death a Natural Cause Accident 0 Homicide 0 Suicide Undetermined Pending
Ul Circumstances Investigation
W Medical Certifier Name Title
Michael Fuller, M.D
Address
100 Park Street Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village 4/6t!o 2 y3
®Burial Date Cemetery or Crematory
December 12, 2016 Pine View Cemetery
❑Entombment Address
0 Cremation Quaker Rd. Queensbury,NY 12804
Date Place Removed
• Removal
O and/or and/or Held
Hold Address
I, -` Pine View Cemetery
N Date Point of
2 n Transportation Shipment
O by Common Destination
O 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
I— Remains are Shipped, If Other than Above
• Address
CC
CL
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued /2//,2l/L Registrar of Vital Statistics _,a.4`., 4 ' `1:0_
(signature)
District Number y_(� Place ?tj/1 o r iX A rC r4..6-
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
w Date of Disposition 12/12/2016 Place of Disposition Quaker Rd. Queensbury,NY 12804 , Pine View Cemetery
W (address)
CO Oneida 206A 2
ay (section) (lot number) (grave number)
a Name of Sexton or Person in Charge of Premises Connie L. Goedert
z (please print)
W Signature Title Cemetery Superintendent
(over)
DOH-1555 (02/2004)