Herring, Raymond B. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Raymond B Herring Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/23/2020 88 Years War or Dates 1952-1954
Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
'p Mannerof Death N1 Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
II1J Medical Certifier Name Title
Gwendolyn Morris-Dickinson PA
Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601
Burial Date Cemetery,Crematory or Facility Name
03/26/2020 Pine View Crematory
Entombment Address
0 Cremation Queensbury Town,New York
Donation
� ❑Removal Date Place Removed
and/or and/or Held
r Hold Address
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N ❑Transportation Date Point of
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
,!E Address
W
!IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/26/2020 Registrar of Vital Statistics Wodeaf4ndrewCiirtir�!Yectronica1TySWne4
(signature)
District Number 5601 Place Glens Falls, New York
t I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition �^ZQ-ZD Zv Place of Disposition ?J),1 40) 'Lt r} 4�-41'Q h-c c. cir
X. (address)
W
N IX (section) (lo number/ (grave number)
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Name of Sexton or Perso a of Premises —emu �''� 4 m�/� -2
Z (please print)
IU Signature TitleL.
DOH-1555 L
(o7/18)p 192
Public Health Law Sec. 4145(2b) 1113473
Receipt
Human remains of '" delivered on , 20"
f :r
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#