Dumas, Mark NEW YORK STATE DEPARTMENT OF HEALTH —14 ** 14 M
Vital Records Section Burial - Transit Permit
,
k Name First Middle Last Sex
'4 Mark Andrew Durnas Male
.:" Date of Death Age If Veteran of U.S. Armed Forces,
, 04/10/2018 61 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death rul
LA j Natural Cause 0 Accident 0 Homicide Ei Suicide ri Undetermined El Pending
'Circumstances '—'Investigation
Medical Certifier Name Title
Abigail Macomber PA
*--
Address
io 100 Park St,Glens Falls,New York 12801
0-1
Death Certificate Filed District Number
---* Register Number
City, Town or Village Glens Falls 5601 178
,—,
LIBurial Date Cemetery or Crematory
'41 r-i 04/11/2018 Pine View Crematorium
u Entombment Address
-k-N'EICremation Queensbury Town, New York
4-4k
Date Place Removed
6,-W1 ri Removal and/or Held
and/or Address
i Hold
Date Point of
Cli r-I
0 Li Transportation Shipment
by Common Destination
Carrier
1-41 j r--1 Disinterment Date Cemetery Address
tiA L
*.,
rl R 'ki L...j einterment Date Cemetery Address
Permit Issued to Registration Number
It Name of Funeral Home Carleton Funeral Home Inc 00281
Address
t 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
Permission Is hereby granted to dispose of the human remains described above as indicated.
AV, .
'-* Date Issued 04111/2018 Registrar of Vital Statistics Apoert_A Curtis rEketiOniCarry Signed)
N-,
-44 (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:
W. Date of Disposition 11 I IL It Place of Disposition f? V.....- I tftki 6 eli--
(address)
ri
144 (section) li. (lot number)r„ (grave number)
Name of Sexton or Person in Charge of Premises iinsite- _.)wq li tt
A L/1-41a... Title 0,1 ase print)
Signature
Itif-114,g/
(over)
DOH-1555 (0212004)