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Audette, Michael NEW YORK STATE DEPARTMENT OF HEALTH 76) Vital Records Section Burial - Transit Permit Name First Middle Last Sex Michael Robert Audette Male Date of Death Age If Veteran of U.S. Armed Forces, 09/09/2018 59 Years War or Dates 1977-1979 Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital tp Manner of Death® Natural Cause El Accident �Homicide Suicide ❑Undetermined Pending Circumstances Investigation tu Medical Certifier Name Title Michael Adams MD Address 100 Park St,Glens Falls.New York 12801 rir Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 434 ❑Burial Date Cemetery or Crematory 09/19/2018 Pine view Crematorium ❑Entombment Address ®Cremation Queensbury Town. New York Date Place Removed Removal and/or Held ... and/or Address F- Hold fA 0 Date Point of L_.t Transportation Shipment 3 by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address 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 Name of Funeral Firm Making Disposition or to Whom I— Remains are Shipped, If Other than Above Address CC ll ' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/1212018 Registrar of Vital Statistics po6ertA Curtis'E1:ctronicaffySigned) (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: Ill Date of Disposition 4 J11(is Place of Disposition (address) CC (section) (lot n' ber) (grave number) © Name of Sexton or Person in Charge of Premi es Ihr�'ip'VI,- 32a (please print) ▪ Signature Title A(vEMMA. (over) DOH-1555 (02/2004)