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Hayes, Alan N.
W- 3Y NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Alan N. Hayes Male Date of Death Age If Veteran of U.S.Armed Forces, 01/09/2020 84 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital -7 W p Manner of Death ©Natural Cause ❑Accident Homicide ❑Suicide Undetermined Pending UCircumstances Investigation W Medical Certifier Name Title Marvin Davidowitz MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 20 Burial Date Cemetery,Crematory or Facility Name 01/11/2020 Pine View Crematory ❑Entombment Address RI Cremation Queensbury Town,New York ❑Donation Z Removal Date Place Removed and/or and/or Held f- Hold Address N O (L Date Point of U) ❑Transportation p by Common Shipment Carrier Destination Ej Disinterment Date Cemetery Address EjDate Cemetery Address Reinterment Permit Issued to Registration Number Name of Funeral Home Miller Funeral Home 01199 Address 6357 Nys Rte#30, Indian Lake,New York 12842 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address W I' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/10/2020 Registrar of Vital Statistics Robert Andrew Curtis(Electronically 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: Z Date of Disposition _ yp Place of Disposition "7'Ne it 10oc uJ ad ress/ W U) (section) lot number/ (grave number) Name of Sexton or Person in C rge of Pre es Z LyG (please print) IW Signature Title DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) v 0 13 2 Receipt Human remains of n�). delivered on , 20 Pine View Cemetery Represent i g the funeral home named on burial permit Official Funeral Directors Reg.or License#,