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Jones, David
1690 NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex David Basil Jones Male Date of Death Age If Veteran of U.S. Armed Forces, 10/05/2019 98 Years Waror Dates 1944-1946 F. Place of Death Hospital, Institution or Z City, Town or Village Granville Town Street Address 7187 Route 149, Granville Town, New York 12832 p Manner of Death © Natural Cause Accident Homicide Suicide ❑ Undetermined Ej Pending uJ Circumstances Investigation U W Medical Certifier Name Title James North MD Address 9 Carey Road, Queensbury Town, New York 12804 Death Certificate Filed District Number Register Number City, Town or Village Granville 5756 84 Burial Date Cemetery, Crematory or Facility Name Pine View Crematorium El10/11/2019 Entombment Address X❑ Cremation Queensbury Town, New York Donation z Removal Date Place Removed and/or Held H and/or Hold Address N O d Date Point of N 25 Transportation by Shipment Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Stpo Box 67, Hudson Falls, New York 12839 Name of Funeral Firm Making Disposition or to 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 10/09/2019 RegistrarofVital Statistics Jenny Linda WarteCCe(ECectronicallySigned) /signature/ District Number 5756 Place Granville, 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 10111,111 Place of Disposition ui (address) uJ Cl) cc (section) (lot number) (grave number) a Name of Sexton or Person in Charge of Premises ( p ase print/ Z W Signature Title e ' DOH-1555 (o7/18) p lot 2 Public Health Law Sec. 4145(2b) u1259J Receipt Human remains of .J J( 1)I lam' delivered on ; t .- i , 20 1 Pine View Cemetery Representing the funeral home named pn,bydaLermt Official Funeral Directors Reg. or License # "-