Krehbiel, Steven --/X2 1
NEW YORK STATE DEPARTMENT OF,OIEA01H
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Steven Allen Krehbiel Male
Date of Death Age If Veteran of U.S. Armed Forces,
March 12, 2017 49 War or Dates
wPlace Qf ath Hospital, Institution or
_. City, T _
W �r Village t n SiD t.t,rti/ Street Address 30 Green Acres Road
W Manner of Death❑Natural Cause ❑ Accident El Homicide El Suicide ❑ Undetermined ❑ Pending
0 Circumstances Investigation
W Medical Certifier Name Title
Nadarajah Balasubramaniam,
Address
50 Broad Street Waterford, NY
Death Yicate Filed11,, District Number Register Number
City, wn r Village T1 / r ✓ S 6 u l J 5 -1 6 �'
44 0 Burial Date Cemetery or Crematory '_---
March 20, 2017 Pine View Crema
❑Entombment Address
t®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal
and/or Held
co and/or Address
E Hold
N Date Point of
❑Transportation Shipment
(I) by Common Destination
i Carrier
❑ Disinterment
Date Cemetery Address
f � I: Reinterment Date Cemetery Address
,, Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
F- Remains are Shipped, If Other than Above
• Address
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 3) /t,//7 Registrar of Vital Statistics 6 c. . C . .,--e,
(signature)
District Number 5-76 Place TA,v-,, i f it, J S in.,_(
J
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
la Date of Disposition 03/20/2017 Place of Disposition Quaker Road Queensbury,NY 12804 Phevield ix,Jny
(address)
ill09
(t (section) ` (lot number) f (grave number)
O Name of Sexton r n in Charge of Premises -Jw l i�4' cl`Ae-
z ,/ (please print)
W Signature ,/C--- Title e-e- e-
(over)
DOH-1555 (02/2004)