Houghton, Douglas cg
NEW YORK STATE DEPARTMENT OAF HEALTH
Vital Records Section Y Burial - Transit Permit
• " Name First Middle Last Sex
Douglas B. Houghton Male
Date of Death Age If Veteran of U.S. Armed Forces,
January 13,2017 68 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
0` Manner of Death X Natural Cause Accident 1 1 Homicide Suicide Undetermined Pending
W Circumstances Investigation
#w▪ Medical Certifier Name Title
'd: Bryan Smead
Address
Bolton Health Center,Bolton Landing,NY 12814
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 L1 .Z
❑Burial Date Cemetery or Crematory
January 17,2017 Pine View Crematory
111 Entombment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
ZZ I I Removal and/or Held
and/or Address
—_I— Hold
N
O Date Point of
u) Transportation Shipment
p 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
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
:14.' Remains are Shipped, If Other than Above
a',�s Address
w;
Permission is hereby granted to dispose of the human remains described above s indicated.
Date Issued R / i 7 1 1 7 Registrar of Vital Statistics `,AiCti TYN-ct.
1 4.
(signatur
District Number 5 bO ( Place 6 c'v`S ` `S� N L'
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition ///07 Place of Disposition Piet i.,) -'�t�,4
W (address)/
co
O (section) `` zilot number) (grave number)
QName of Sexton 0,: n 'n Charge of Premises �J LA /r o-vl. ( `3 .-fri 4: �4 e
Z (please print)
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Signature Title C re ria V C,i�,c7Q7c4�a"
l/ (over)
DOH-1555 (02/2004)