Loading...
Garand, Andrew NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section \ k Burial - Transit Permit 1 Name First Midd Last Sex Andrew Oliver :rand Male Date of Death Age . Armed Forces, January 12, 2017 74 Place of Death Hospi =, nstitution or ris s City, Town or Village Glens Falls Street Address Glens Falls Hospital I. F Manner of Death mj Natural Cause ❑ Accident ❑ Homicide E Suicide ❑ Undetermined ❑ Pending Circumstances Investigation W Medical Certifier Name Title , Stephen Perazzelli, 000 Address 100 Park Street Glens Falls, NY 12801 4.4 Death Certificate Filed District Number Register Number 00 City, Town or Village Glens Falls (a o r 3 5 "'❑Burial Date Cemetery or Crematory January 11 2017 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed ❑ Removal and/or Held and/or Address Hold Date Point of ❑Transportation Shipment by Common Destination Carrier 00. ❑ Disinterment Date Cemetery Address g Reinterment Date Cemetery Address tse Permit Issued to Registration Number 02 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 Remains are Shipped, If Other than Above °; Address Permission is hereby granted to dispose of the human remains described above as indicated. " Date Issued 1 !t 1 /Z'1 --(Registrar of Vital Statistics (�c'�'�' ALA,), ^- (signature) • District Number 560! Place 6 ����F& certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 01/13/2017 Place of Disposition Quaker Road Queensbury,NY 12804 (address) (section) /(lot number) r, (grave number) Name of Sexton or Person in Charge of Pr ises (I fir 0 J•-tea tit (ease print) r" Signature a Title AFMVk7i1 (over) DOH-1555 (02/2004)