Hunt, Everett NEW YORK STATE DEPARTMENT OF HEALTH rt •rP 4 4r I L
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
05
Everett P, Hunt Male .
Date of Death Age If Veteran of U.S. Armed Forces,
March 14, 2011 88 yrs. War or Dates ' 40- ' 45
1- Place of Death Hospital, Institution or
ta
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death®Natural Cause 1p Accident 1=IHomicide El Suicide Ei Undetermined ri Pending
US Circumstances Investigation
Ili Medical Certifier Name Title
0 Suzanne /Rayeski DO.
Address
3767 Main St. , Warrensburg, NY. 12885
Death Certificate Filed District Number Registerl Number
iin City, Town or Village Glens Falls 561/ / a 7
❑Burial Date Cemetery or Crematory
March 17, 2011 PineView Crematorium
❑Entombment Address
lillilii EjCremation Queensbury, NY.
Date Place Removed
gEl Removal and/or Held
and/or Address
h' Hold
CA
0 Date Point of
clik ❑Transportation Shipment
Li by Common Destination
iN Carrier
El Disinterment Date Cemetery Address
E Reinterment Date Cemetery Address
s Permit Issued to Registration Number
Name of Funeral Home Mason Funeral Home 01136
in Address
18 George St. , Fort Ann, NY. 12827
Ni Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
fir
ill
Permission is hereby granted to dispose of the human remains descr'bed bov as in ' a d.
Date Issued 0 3/1 5/1 1 Registrar of Vital Statistics � �
(signature)
District Number f j/ Place city of Glens Falls, NY.
LW I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I Date of Disposition 3-)$�-t i Place of Disposition ( huutiw (,,rern.4vr,,,,�
(address)
fAi
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CC (section) /1h1 r (lot number) (grave number)
Name of Sexton or Pers n in Charge f Premises L e•3 tf itr St.twit
Z (please print)
ILI mi Signature (1
g Title CUE 1 b W1L
(over)
DOH-1555 (02/2004)