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Longdaue, Paul NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Per it Name First Middle Last Sex , Paul Eugene Longdaue Male Date of Death Age If Veteran of U.S. Armed Forces, { 06/16/2018 84 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Granville Village Street Address Indian River Rehabilitation And Nursing Center Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title Thomas Kandora MD Address ..,:t 17 Madison St,Granville Village,New York 12832 Death Certificate Filed District Number Register Number City, Town or Village Granville Village 5725 27 ❑Burial Date Cemetery or Crematory Ft 06/19/2018 Pine View Crematory ❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed ❑Removal and/or Held - and/or Address Hold Date Point of k :0 Transportation Shipment by Common Destination Carrier 14 Disinterment Date Cemetery Address Reinterment Date Cemetery Address 01 Permit Issued to Registration Number 07 Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above 5iAddress Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/19/2018 Registrar of Vital Statistics Wic/ardRp6erts(E(ectronica(CySigned) (signature) District Number 5725 Place Granville Village, New York 444 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition (0 I zo lt$ Place of Disposition R3U..� I?j(1,_ (address) 7-1 (section) lot number) (grave number) Name of Sexton or Person in Charge of Premises l Ira S /II (plee e print) Signature Get ` Title 't?10:) (over) DOH-1555 (02/2004)