Gleason, Raymond NEW YORK STATE DEPARTMENT OF REALTH)
Vital Records Section Burial - Transit Permit
;-. Name First Middle Last Sex
10 Ra mond Clifford Gleason Male
Date of Death Age If Veteran of U.S. Armed Forces,
May 22, 2017 63 War or Dates
a -.lac of Death Hospital, Institution or
City own or Village Glens Falls Street Address 10 McDonald Street
mi anner of Death 0 Natural Cause 0 Accident El Homicide Suicide El Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
of Paul F Bachman MD,
Address
Warrensburg Health Center Warrensburg, NY 12885
►'- a Certificate Filed District Number Register Number
ity, own or Village _1 k ir,s # c.l\S, 5601
ii :urial Date Cemetery or Crematory
May 25, 2017 Pine yew Crematorium
❑Entombment Address
i ®Cremation Queensbury,NY 12804
': Date Place Removed
Removal and/or Held
and/or Address
rl Hold
,77 Date Point of
r4''❑Transportation Shipment
' by Common Destination
Carrier
,, Date Cemetery Address
Disinterment
Reinterment
Date Cemetery Address
Al 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
* Remains are Shipped, If Other than Above
Address
lifice-
,43-7
Permission is hereby granted to dispose of the human remains described above as in4icate .
Date Issued .S b as-)l 17 Registrar of Vital Statistics t C�AJA 'v•-Q' W
�` f (signature)
o District Number 5601 Place G <.4i1/\5 t'C.�� `\s ,m y
mi
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tri Date of Disposition 05/25/2017 Place of Disposition Queensbury,NY 12804
(address)
la
(section) pot number) (grave number)
a �tc Name of Sexton or Person in Charge of Premises L t, r Jti+ftti-
(ple se print)
Signature Gil "-: Title &V
eit
(over)
DOH-1555 (02/2004)