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Bowman, Ernest It it 1 . 4 (c. NEW YORK STATE DEPARTMENT OF HEALTO Vital Records Section Burial - Transit Permit • Name First Middle Last Sex Ernest Eugene Bowman Male Date of Death Age If Veteran of U.S. Armed Forces, December 02,2018 48 War or Dates l Place of Death Hospital, Institution or Z. City, Town or Village Hudson Fallsikt Street Address 33 Delaware Ave `LI © Manner of Death®Natural Cause ❑Accident ElHomicide ElSuicide ❑Undetermined El❑Pending Circumstances Investigation Ltf Medical Certifier Name Title Michael Sikirica MD Address Albany,NY 12205 . Death Certificate Filed District Number Reei t r Number City, Town or Village Hudson Falls 5'(• E., :s ❑Burial Date ! Cemetery or Crematory December 06,2018 Pine View Crematorium 44 0 Entombment Address 4,,, ®Cremation Quaker Road,Queensbury,NY Date Place Removed d❑Removal and/or Held and/or Address F Hold N © Date Point of d Transportation Shipment ci UT❑ by Common Destination Carrier xi Q Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home,Inc. 00281 Address 41 68 Main Street,Hudson Falls,NY 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address UI a` Permission is hereby granted to dispose of the human remains d. ribed above as indicated. Date Issued -6 -a Registrar of Vital Statistics . L,� ;;•.QS%1 )._0 `- (signature) District Number y 6 Place _,,• ,� iii L���- '4 ,.$) , r,.. 1 (•.. ;>_— 1 I certify that the remains of the decedent identified aovdiwere disposed of in accordance with this permit on: Z Date of Disposition RI) li5' Place of Disposition cut!..." (ITO'S."(ot ,., X (address) CO3 W (section) A(lot number) (grave number) aName of Sexton or Person in Charge of Premises l h 41-hgivr S e-.,lift Z {' (please print) W Signature *';' Title rRmtfi 1 .L (over) DOH-1555 (02/2004)