Loading...
Goodwin, David NEW YORK STATE DEPARTMENT OF HEALTH r i 9 Vital Records Section Burial - Transit Permit Name First Middle Last Sex David Ira - Goodwin Male Date of Death Age If Veteran of U.S. Armed Forces, February 11, 2017 66 War or Dates ZPlace of Death Hospital, Institution or W City, Town or Village Glens Falls Street Address Glens Falls Hospital W• Manner of Death 0 Natural Cause III Accident Homicide Suicide ❑ Undetermined Pending Circumstances Investigation W© Medical Certifier Name Title Stephen Perazzelli, M.D Address 100 Park Street Glens Falls, NY 12801 Death Certificate Filed District Num �� Register ummer B)Town or Village ��r� n s i 1T urial Date Cemetery or Crematory oZ-(.; 1- 11 Pine View Crematorium 0 Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z El Removal and/or Held • and/or Address F Hold 0 Date Point of a0 Transportation Shipment CO by Common Destination 8 Carrier Disinterment Date Cemetery Address 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 1- Remains are Shipped, If Other than Above 2 Address X W Permission is hereby ranted to dispose of the human remains descri a ov as ' i ated. Date Issued 4,2 lY 2o/7 Registrar of Vital Statistics . / (signature) District Number S6 0/ Place CYe A- J /04 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition < / Place of Disposition Quaker Road Queensbury,NY 12804 tR)-2 v/ Je-op 4 hr,� 2 (address) W W (section) k (VA umber) // ► i (grave number) 0p Name of Sexton or P s ,.- Ch ge of,Premises iti/i etvi tccor -!tee z � (please print) W Signature Title creme (over) DOH-1555 (02/2004)