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Huntington Jr., Adoniram I NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Adoniram J.Huntington Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, t 07/21/2017 81 Years War or Dates 1952-1957 1... Place of Death Hospital, Institution or W City, Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc W Manner of Death X❑Natural Cause ❑Accident El Homicide ❑Suicide El Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title © Nawed Siddiqui MD Address ,' 319 Broadway,Fort Edward Town,New York 12828 Death Certificate Filed District Number Register Number City, Town or Village Fort Edward 5755 35 ®Burial Date Cemetery or Crematory 07/29/2017 Pine View Cemetery Entombment Address ❑Cremation Queensbury Town, New York Date Place Removed Z❑Removal and/or Held 9 and/or Address Hold CO 0 Date Point of Q. Transportation Shipment ci by Common Destination Carrier ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address a Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 • Address 68 Main Stpo Box 67,Hudson Falls,New York 12839 • Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above • Address CE Ltl C; Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/24/2017 Registrar of Vital Statistics Aimee Mahoney TElectronicaaySigned" (signature) District Number 5755 Place Fort Edward, New York N I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition Place of Disposition 2 (address) I LI Ca te (section) (lot number) (grave number) pName of Sexton or Person in Charge of Premises Z (please print) W Signature Title (over) DOH-1555 (02/2004)