Parsons, Steven . tf 71
NEW YORK STATE DEPARTMENT OF HEALTH,
Vital Records Section •• Burial - Transit Permit
Name First Middle Last Sex
• Steven Michael Parsons Male
Date of Death Age If Veteran of U.S. Armed Forces,
0923/2018 79 Years War or Dates
F Place of Death Hospital, Institution or
Z City, Town or Village Glens Fallsiii Street Address Glens Falls Hospital
Q Manner of Death®Natural Cause Accident ❑Homicide El Suicide El Undetermined �Pending
W Circumstances Investigation
W Medical Certifier Name Title
O Michael Miles MD
Address
100 Park St,Glens Falls,New York 12801
• Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 455
Date Cemetery or Crematory
• ❑Buda) 09/26/2018 Pine View Crematorium
• Entombment Address
i ®Cremation Queensbury Town, New York
A
Date Place Removed
fl U Removal and/or Held
and/or Address
N Hold
O Date ' Point of
IL
❑Transportation Shipment
by Common Destination
_:', Carrier
Disinterment Date Cemetery Address
r` 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
CC
LU
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/25/2018 Registrar of Vital Statistics Robert A Curtis(Etectronr'rvtrySig
(signature)
District Number 5601 Place Glens Falls. New York
i- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition Place of Disposition
2 (address)
W
'I)
e (section) (lot number) (grave number)
aName of Sexton or Person in Charge of Premises
Z (please print)
W Signature Title
(over)
DOH-1555(02/2004)