Stiles, Harold NEW YORK STATE DEPARTMENT OF HEALTH r ' R lO3 Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Harold Ellsworth Stiles Male
Date of Death Age If Veteran of U.S. Armed Forces,
November 3, 2018 74 War or Dates
ZPlace of Deat Hospital, Institution or
City, Town or illag Hudson Falls Street Address 12 Alma Ave
C Manner of D Undetermined Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Udt id ❑ Pending
W Circumstances Investigation
WMedical Certifier Name Title
Ci Philip J Gara Jr. MD,
Address
327 Broadway Fort Edward, NY 12828
Death Certific- ' -d District Number Register Number
City, Town or i ag: >4 rls v,r, j,Jjt s SS7.2 6 �Y
❑Burial 1- - Cemetery or Crematory
November 5, 2018 Pine View Crematorium
0 Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
Z ❑ Removal and/or Held
and/or Address
F. Hold
coDate Point of
d ❑Transportation Shipment
40 by Common Destination
p, Carrier
Disinterment Date Cemetery Address
Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
I-` Remains are Shipped, If Other than Above
2 Address
W
C1.' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued /j/ ,/.24 4 Registrar of Vital Statistics er 4 ,„ _
(signature)
District Number s- a G Place c _I _ Gy /41 .�a
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 11/05/2018 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
Ili"
Cl)'
ft (section) (lot number) (grave number)
0 kr
Name of Sexton or Person in Charge of Premises ari' °�`�`^ ,. /N-
(pl ase print)
W Signature d��' Title 4i
Nt
(over)
DOH-1555 (02/2004)