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Steele, Thomas t NEW YORK STATE DEPARTMENT OF HEALTH t 4 '" Vital Records Section Burial - Transit Permit Name First Middle Last Sex ,f Thomas Cameron Steele Male Date of Death Age If Veteran of U.S.Armed Forces, IX 08/24/2017 88 Years War or Dates 11-tfr Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ri❑Undetermined ❑Pending Circumstances Investigation uj Medical Certifier Name Title a Michael Fuller MD `- Address 100 Park St,Glens Falls,New York 12801 3 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 453 ❑Burial Date Cemetery or Crematory 08/28/2017 Pine View Crematorium ❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed =Z❑Removal and/or Held 0 and/or Address F Hold 0 0 Date Point of to❑Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address 4� Date Cemetery Address i Q Reinterment Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 = Address v68 Main Stpo Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above 2' Address re Ltd 4' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/28/2017 Registrar of Vital Statistics wp6ert A Curtis ECectronica1CySigned (signature) i-J,r, District Number 5601 Place Glens Falls, New York T I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition 01O Place of Disposition eit4,1,--d ervr..g4tc, 2 (address) ili Ca rt (section) _ (l number) (grave number) p Name of Sexton or Person in Charge of Premises ,1'• .>i�r4 Z lease print) W Signature _ Title I2 (over) DOH-1555 (02/2004)