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Strong Sr, Forrest
44„.. 4/.3 7 e NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section c - Burial - Transit Permit r. t. Name First Middle Last 1 Sex Forrest Clayton Strong Sr. I Male Date of Death , Age ' If Veteran of U.S.Armed Forces, 6/14/2016 k 70 War orDates 1967-71 1-. Place of Death Hospital. Institution or a City. Town n or Village Glens Falls Street Address Glens Falls Hospital Ca Manner of Death[ Natural Cause 0 Accident 0 Homicide ©Suicide ri Undetermined ri Pending Circumstances Investigation lc Medical Certifier Name Title 0 Dr. Hoy 161 Carey Road Queendsbury, New York 12804 Death Certificate Filed 1 District Number 1 Register Number¢ City,Town or Village Glens Falls TOO) J fl6uriai , Date 6/16/2016 'Cemetery or Crematory ❑Entombment Address —_ Pine View Crematory ]Cremation 21 Quaker Road, Queensbury New York 12804 Date Place Removed Z El Removal and/or Held and/or Hold � Address 0 1, Date Point of Transportation 1 Shipment a by Common ; Destination � Carrier Disinterment Date Cemetery Address 0 Remterment * Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M.B. Kilmer Funeral Home (1078 Address 136 Main Street, South Glens Falls, NY 12803 Name of Funeral Firm Making Disposition or to Whom h Remains are Shipped, If Other than Above Address C" Permission is hereby granted to dispose of the human r mains d scribed ,ova as indi - Date Issued /,OLa iiv rwv6 Registrar of Vital Statistics District Number Jr'�© � Place j� / F- I certify that the remains of the decedent identifi a. e were disposed of in accordance with is permit on: Date of Disposition 4/10(15, Place of Disposition 1iL 't,o... (amass) fsrcbon) flat number) (Brace number) of Sexton or Person in Charge of Premises t �J(L fit y riset," Signature .4— Title `O IT/7/ (over) DOH-1555(02/2004)