Dundon, John NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
e Name First Middle Last Sex
John Joseph Dundon Male
Date of Death Age If Veteran of U.S. Armed Forces,
re 04/21/2018 57 Years War or Dates
�= Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Fans Hospital
01 Manner of Death Natural Cause Accident Homicide Suicideri Undetermined �Pending
Circumstances Investigation
iil Medical Certifier Name Title
William Cleaver MD
Address
17 100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Fans 5601 206
❑Burial Date Cemetery or Crematory
04/23/2018 Pine View Crematorium
AI ❑Entombment4. Address
VaCremation Queensbury Town, New York
Date Place Removed
Removal and/or Held
• and/or Address
Hold
• Date Point of
Li Transportation Shipment
by Common Destination .
Carrier
❑Disinterment Date Cemetery Address
• Rei
Date Cemetery Address
nterment
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
a Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
bi Address
Pi
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/23/2018 Registrar of Vital Statistics Rpbert,4 Curtis tEtectranrcak))Signed)
(signature)
• District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition lCZt4 fig Place of Disposition 64,,., !/ }orw.,
(address)
Lti
, (section) ^.,(lot number)(, (grave number)
L. Name of Sexton or Person in Charge of Pr mises l a,itf
( ease print)
Signature Title F L
(over)
DOH-1555(02/2004)