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Powers, Edward it a, 411 NEW YORK STATE DEPARTMENT OF HEALTH Burial . Transit Permit Vital Records Section Name First Middle Last Sex - Edward James Powers Male Date of Death Age If Veteran of U.S. Armed Forces, _ 01/11/2018 81 Years War or Dates 1960-1962 i— Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation W Manner of Death©Natural Cause Accident 0 Homicide D Suicide 0 Undetermined Pending Circumstances Investigation W Medical Certifier Name Title O Carrie Miron PA Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 16 r El Burial Date Cemetery or Crematory 01/12/2018 Pine View Crematorium ❑Entombment Address ®Cremation Queensbury Town, n Yc Date ' Place Removed Z❑ _ Removal and/or Held H and/or Address N Hold O Date Point of ' N 0 Transportation Shipment O by Common Destination Carrier El Disinterment Date Cemetery Address Q 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 I— Remains are Shipped, If Other than Above 2 Address W W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/12/2018 Registrar of Vital Statistics cp6ertA Curtis(ECectronicaliySigned) (signature) District Number 5601 Place Glens Falls, New York F,. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z v w Date of Disposition (/I( (R Place of Disposition Imo-- W (address) Cl) W (section) A (lot number) (grave number) pName of Sexton or Person in Charge of Pref ises d LAv 3 ivi W z `9 (phase print) Signature �"� ,/['" Title Lpt (over) DOH-1555 (02/2004)