Emery, Kenneth jtfo?NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Kenneth A. Emery Male
Date of Death Age If Veteran of U.S. Armed Forces,
01 / 30 / 2018 52 War or Dates
14 Place of Death Hospital, Institution or
ZCity, Town or Village Glens Falls Street Address 33 Haskell Ave.
a Manner of Death❑ Natural Cause 0 Accident 0 Homicide NSuicide "—I Undetermined 0 Pending
ILI Circumstances Investigation
W Medical Certifier Name Title
0 Timothy Murphy Coroner
Address
52 Haviland Avenue, Glens Falls, NY 12801
Mi Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls ��"(OC) / .6-9
ii ji! ElBurial Date Cemetery or Crematory
02 / 01 / 2018 Pine View Crematory
is In Entombment Address
ilig®x Cremation Queensbury, NY
Date Place Removed
Removal and/or Held
and/or Address
0. Hold
In
0 Date Point of
04.'1Q Transportation Shipment
a by Common Destination
WC Carrier
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Ui]iiPermit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
1 402 Maple Ave., Saratoga Sp., NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Zi Address
tr.
ILI
` Permission is hereby granted to dispose of the hum remains described ove as in, icated.
iinii
Date Issued ( 21 O 1/ xieistrar of Vital Statistics %�f��
(( i n re)
MI District Number --t`�,) / Place ens Falls , New York
•
1*- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
III Date of Disposition if Z.,II Place of Disposition �V� !c.4_...
a (address)
ili
tl
ir (section) A(lot number (grave number)
QName of Sexton or Person in Charge of Pre es r:`H �NT
( ease print) •
iiii Signature "ifTitle rr tr:t Intifi
(over)
DOH-1555 (02/2004)