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Hessler, Richard NEW YORK STATE DEPARTMENT OF HEALTH #. 27 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Richard Hessler Male Date of Death Age If Veteran of U.S. Armed Forces, April 1, 2017 82 War or Dates Place of Death Hospital, Institution or w City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death Natural Cause ❑ Accident E Homicide ❑ Suicide ❑ Undetermined ❑ Pending Hi Circumstances Investigation W Medical Certifier Name Title a Christopher D. Hoy, M.D. Dr. Address 102 Park St. Glens Falls, NY 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls ❑Burial Date Cemetery or Crematory April 5, 2017 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed 2 ❑ Removal and/or Held and/or Address Hold .011 8 Date Point of 4: ❑Transportation Shipment • by Common Destination 0 Carrier Date Cemetery Address El Disinterment Date Cemetery Address ❑ Reinterment Permit Issued to Registration Number Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078 Address 136 Main Street, South Glens Falls NY 12803 Name of Funeral Firm Making Disposition or to Whom tom, Remains are Shipped, If Other than Above Address i tt" Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 4 l 5 . 1,'7 Registrar of Vital Statistics U.) CA,, y- W—A-A (signature) District Number 5 60 i Place 6 Cc2rv'S k 1 5 )iJ t ) I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: II— W Date of Disposition 04/05/2017 Place of Disposition Quaker Road Queensbury,NY 12804 (address) I (section) ,. (lot number)( (grave number) Name of Sexton or Person in Charge of Premises IA r r J u+4/t �/ ( lease print) U Signature C Title C(�' @ilr1"Dit (over) DOH-1555 (02/2004)