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Hayes Sr., Charles NEW YORK STATE DEPARTMENT OF HEALTH 1 Vital Records Section Burial _ Transit Permit , F "F Name First Middle Last Sex Charles John Hayes Sr. Male Date of Death Age If Veteran of U.S. Armed Forces, April 21, 2017 88 War or Dates Place of Death Hospital, Institution or City, Town or Village Argyle Street Address Washington Center Manner of Deathm Eli Natural Cause 0 Accident 0 Homicide 0 Suicide 0 Undetermined 0 Pending III Circumstances Investigation a. Medical Certifier Name Title Edit Masaba, MD Dr. Address 35 Gilbert Street Greenwich, NY 12834 Death Certificate Filed District Number Register Number City, Town or Village Argyle 0 Burial Date Cemetery or Crematory April 24, 2017 Pine View Cemetery 0 Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed zri Removal and/or Held and/or Address Hold CA 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 M. B. Kilmer Funeral Home-Argyle 01077 Address 123 Main St., Argyle NY 12809 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address IX ILI E#. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 5150 Registrar of Vital Statistics Sit_e_0_01)11i -. (signature) District Number 13 Place CU\C to t 4 y I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: tu Date of Disposition 04/24/2017 Place of Disposition Quaker Road Queensbury,NY 12804 (address) I (lot number) (grave (section) L number) Name of Sexton or Person in Charge of Pr ises `�r� ' ir .��"''I t(� (pi ase print) l# Signature Title ((E T1t (over) DOH-1555 (02/2004)