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Cass, George Frederick
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vita[Records Name First Middle Last Sex George Frederick Cass Male Date of Death Age If Veteran of U.S.Armed Forces, 12/14/2019 92 Years War or Dates World War II Place of Death Hospital,Institution or Z' City,Town or Village Glens Falls Street Address Glens Falls Hospital ,p Manner of Death ©Natural Cause Accident Homicide Suicide Undetermined Pending (� Circumstances Investigation UJ G Medical Certifier Name Title Gamal Khalifa MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Villa a Glens Falls 5601 535 x❑Burial Date Cemetery,Crematory or Facility Name 12/16/2019 Pine View Cemetery Entombment Address Cremation Queensbury Town,New York Donation Z �Removal Date Place Removed 0 and/or and/or Held N Hold Address O 9L Date Point of N F1 Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition orto Whom �- Remains are Shipped,If Other than Above Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/16/2019 Registrar of Vital Statistics Wpbert,4ndrew Curtis(ECectronicaCly Signed (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: l a 44 W Date of Disposition tLa_ (p . i q Place of Dispositio , � h� (address) W ' O (secti n) (lot number) (grave number/ 0 Name of Sexto r Person in Charge of Premises �A)A) z r�,�, ,,,".� (please print) W Signature `LTA Title DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) U 10 J 5 9 Receipt Human remains of delivered on j' , 2oLL Q�� ; �a e� `Pme View Cemetery Representing the fune al h e named on burial permit Official J Funeral Directors Re or License#�; TT