Greene, Lowell t tW YO* K STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last ' Sex
Lowell Oscar Greene Male
Date of Death Age If Veteran of U.S. Armed Forces,
November 8, 2018 95 War or Dates World War II
wPlace of Death Hospital, Institution or
City, Town or Village Granville Street Address Haynes House of Hope
Manner of Death 0 Natural Cause Accident Homicide Suicide EjUndetermined Ft Pending
Circumstances Investigation
WW Medical Certifier Name Title
Lynn Keil,
Address
HHHN West Mountian Queensbury, NY 12804
Deattl, cate Filed District Number Register Number
City, o r Village GRf3NVILLE S7S, (ob
®Burial Date Cemetery or Crematory
November 13, 2018 Pine View Cemetery
❑Entombment Address
®Cremation Quaker Rd. Queensbury,NY 12804
Date Place Removed
z El Removal and/or Held
p and/or Address
E Hold Pine View Cemetery
CO Date Point of
aEl Transportation Shipment
CA 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
F Remains are Shipped, If Other than Above
2 Address
X
W
d Permission is hereby granted to dispose of the human remains described abo e as indicated.
Date Issued i l 1 acf i.plic Registrar of Vital Statistics c_ A W42u Cage/
(signature)
District Number �1S6 Place TO two 0 F RAW ILLE
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 11/13/2018
JJ p Place of Disposition Quaker Rd. Queensbury,NY 12804
2 (address)
W Uncas #2462 1
re d (section) (lot number) (grave number)
p Name of Sext or Person in Charge of Premises Connie L. Goedert
,Z" / (please print)
W Signature s `ek_` Qciwt/\ Title Cemetery Superintendent
(over)
DOH-1555 (02/2004)