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Hayes Jr. Frederick Charles
NEW YORK STATE DEPARTMENT OF HEALTH - Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Frederick Charles Hayes Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, 04/05/2020 48 Years War or Dates l- Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital tL Mannerof Death W ©Natural Cause Accident Homicide ❑Suicide Undetermined Pending V Circumstances Investigation W Medical Certifier Name Title 0 Matthew Loftus PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 160 Burial Date Cemetery,Crematory or Facility Name 04/07/2020 Pine View Crematorium Entombment Address Cremation Queensbury Town,New York Donation ZO Removal Date Place Removed and/or and/or Held H N Hold Address O d Date Point of N ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Otherthan Above Address IX W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/06/2020 Registrar of Vital Statistics (R96ert,4nd crew Curtis(ECectronicaffy 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: F ( Z Date of Disposition � Place of Disposition L fuw address/ W N (section/ (lot number) (grave number) GName of Sexton or Person in Charge of Premises Z (pie a print) W Signature Title DOH-1555(07/18)p 1 of 2 i Public Health Law Sec. 4145(2b) .. 013515 Receipt Human remains of f �. delivered on j , 20 ` Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#T, ` .