Thew, Troy r*- • 4
NEW YORK STATE DEPARTMENT OF HEALTH i 723
Vital Records Section .Burial - Transit Permit
Name First Middle Last Sex
Troy Joseph Thew Male
Date of Death I Age ' If Veteran of U,S. Armed Forces,
March 20, 2016 I 37 ' War or Dates
t-• Place of Death Hospital, Institution or
Z *tVley,„mckor Village Hudson Falls
JO Street Address 262 Main Street, Hudson Falls, NY
43. Manner of Death rz7luu Natural Cause 0 Accident E]Homicide Ej Suicide n Undetermined n Pending
—.Circumstances "-ainvestistation
m
Medical Certifier Nae Title
a Roberta Miller MD
Address
16 Crimson Oak Ct.,Schenectady. NY
Death Certificate Filed District Number Register Number
l-'
OM/WA%or Village Hudson Falls 5 79. (2 /0
r OBurial Date Cemetery or Crematory
I March 23,2016 Pine View Crematorium
DEntombment Address
OCremation Quaker Road, Queensbury, NY 12804
Date Place Removed
,-„z ri Removal and/or Held
.144 L'and/or Address
Hold
In Li Date Point of
Transportation
Shipment
by Common Destination
, Carrier
E.] Date Cemetery Address
Disinterment
Cemetery Address
0 Reinterment , Date
I Permit Issued to , Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
68 Main Street, Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
f— Remains are Shipped, If Other than Above
Address ..
1r
ILI
CL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 3A.2•• _. 4 9 i (.--, Registrar of Vital Statistics
- 6 ...)-Q_Jot._,.)---e.—____
_
(signature)
District Number s.)---"7,,,Z 6 Place // _e_.,,t7..)— e___. Ed/1 ( ,_„.d2,.0—,—.
I certify that the remains of the decedent identified abov ere disposed of in accordance with this permit on:
ut Date of Disposition 3/25-1)1, Place of Disposition
fi7DtU11.." (..4vet---
2 (address)
Jai
(A
g (section) p
Name of Sexton or Person / ,(lot numbr) (grove number)
ci in Charge f Premises (ht,, LtiAtii,
.Z. please print)
441 Signature a Title 1174 elliOn-
(over)
DOH-1555 (02/2004)