Ashe, Donald c3
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Donald G.Ashe Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/14/2018 66 Years War or Dates
Place of Death Hospital, Institution or
WCity, Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death X❑Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
Matthew Loftus PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 20
❑Burial Date Cemetery or Crematory
01/16/2018 Pineview Crematory
- ID Entombment Address
®Cremation Queensbury, New York
Date Place Removed
zRemoval and/or Held
and/or Address
Hold
Ca
0 Date Point of
Transportation Shipment
by Common Destination
Carrier
El
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Heald Funeral Home Inc 01766
Address
7521 Court Street PO Box 282,Elizabethtown Town,New York 12932
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
Address
ce
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/16/2018 Registrar of Vital Statistics Rg6ertA Curtis(ECectronicaltySigned)
(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:
1/1 Z
Date of Disposition Place of Disposition
'dam (address)
W
l
LL (section) (lot number) (grave number)
Z Name of Sexton or Person in Charge of Premises
(please print)
Signature Title
(over)
DOH-1555 (02/2004)