Fuller, Joseph NEW YORK STATE DEPARTMENT OF HEALTH i /46
Vital Records SectionBurial - Transit Permit
7 Name First Middle Last / Sex
Joseph Robert Fuller`. Male
- Date of Death Age If Veteran of U.S. Armed Forces,
August 12, 2018 53 War or Dates
Place of Death Hospital, Institution or
iJ City, Town or Village Argyle Street Address 146 Pleasant Valley Road
WManner of Death Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
o Circumstances Investigation
W Medical Certifier Name Title
a Max Crossman MD,
Address
Whitehall Family Health Whitehall, NY
Death Certificate Filed District Number Register Number
`'` City, Town or Village 37So a1.z.
•
�E❑Burial Date Cemetery or Crematory
p ,E: August 14, 2018 Pine View Crematorium
❑Entombment Address
`` ®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
and/or
Hold Address
p EVERGREEN CEMETERY(L)
, Date Point of
:el-
-ID❑Transportation Shipment
by Common Destination
Carrier
v Date Cemetery Address
'❑ Disinterment
Date Cemetery Address
❑ Reinterment
::: Permit Issued to Registration Number
iitz etFcr
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
Address
U
z' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued Registrar of Vital Statistics yQ,„4"h t_ E, -
I (signature)
District Number 5150 Place Plici
Y/. 4
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 08/14/2018 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
EI ,
i= (section) /(lot number) (grave number)
2g Name of Sexton or Person in Charge of Premises (l'.: ir. l.._ �JtAAiti
: (please print)
Signature { Title 1/0k
(over)
DOH-1555 (02/2004)