Cormie Sr., Joseph t 14 3)3
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Records Section
is Name First Middle Last Sex
Joseph Thomas Cormie Sr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
=a,' 05/07/2018 86 Years War or Dates 1951-1955
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death IX Natural Cause 0 Accident Homicide ❑Suicide ❑Undetermined Pending
Circumstances Investigation
u Medical Certifier Name Title
0 William Cleaver MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
:: City, Town or Village Glens Falls 5601 224
El Burial Date Cemetery or Crematory
, 05/0912018 Pine View Crematorium
0 Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
c: D Removal and/or Held
and/or Address
Hold
tO
Date Point of
oTransportation Shipment
3 by Common Destination
Carrier
❑Disinterment Date Cemetery Address
::,El Reinterment
Date Cemetery Address
Permit Issued to Registration Number
II Name of Funeral Home Carleton Funeral Home Inc 00281
Address
• .x 68 Main Stpo Box 67,Hudson Falls,New York 12839
t Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
W
Permission is hereby granted to dispose of the human remains described above as indicated.
It
Date Issued 05/08/2018 Registrar of Vital Statistics Rp6ertA Cu ris(ECectranicatl Signed)
-- ` (signature)
ki District Number Place
1 5601 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 G J I Ili Place of Disposition e6..,11, t 44,._
2 (address)
61
Cr., (section) iiyi (lot number) (grave number)
• Name of Sexton or Person in Charg of Premises ii.,,, 1 fs-^"it
�/ /please pri
LP Signature L� q+ Title 1P4401,
(over)
DOH-1555 (02/2004)