Loading...
Younes, John • / )oZ- NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex John Younes Male Date of Death Age If Veteran of U.S. Armed Forces, 12/27/2017 82 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title -`' 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 675 Burial Date Cemetery or Crematory 12/29/2017 Pine View Crematory :, ❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed ❑Removal and/or Held and/or Address Hold Date Point of ❑Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 • Address s; 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address 3== Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/28/2017 Registrar of Vital Statistics Rg6ertACurtis ECectronuaaySigned (signature) j; 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: Date of Disposition /z/-z9/j7 Place of Disposition Py,y)Q f;(�ft1 (/ev-'t ��/i• / (address) (section) (lot flu ber) (grave number) Name of Sexton or P sP '. charge of Premises i,� /t t�14 C.2C.;04 1 a 4-1, (please print) Signature Title � /.e m a//'— (over) DOH-1555 (02/2004)