Powers, Joseph 404
NEW YORK STATE DEPARTMEIr+ OF HEALTH y 1
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Joseph Aloysius Powers Male
Date of Death i Age If Veteran of U.S.Armed For.--
6/24/2016 93 War or Dates �f w IL
Place of Death Hospital. Institution or
City, Town or Village South Glens Falls Street Address Deceased's Residence
1 Manner of Death trjr71 Natural Cause ❑Accident ❑Homicide fl Suicide ri Undetermined ❑Pending
Circumstances Investigation
tuMedical Certifier Name Trj e
O �
Alicia Earley ''fir//
Address
161 Carey Road Queensbury,New York 128.04
Death Certificate Filed District Number Register Number
City, Town or Village South Glens Falls
❑Burial Date Cemetery or Crematory
6/28/2016 Pine View Crematory
❑Entombment Address
]Cremation 21-Quaker Road,Queensbury New York 12804
Date Place Removed
Z a Removal and/or Held
and/or Hold Address
Date Point of
a0 Transportation 1 Shipment
a by Common j Destination
Carrier
Disinterment Date Cemetery Address
❑Reinterment r Date Cemetery Address
Permit Issued to ; Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home - South Glens Falls i 01078
Address
136 Main Street, South Glens Falls,NY 12803
Name of Funeral Firm Making Disposition of to Whom
Remains are Shipped. If Other than Above
ai Address
CC
tit _.—_--;-.
G. Permission is hereby granted to dispose of the human remai scribed abovI indicated.
Date Issued �f 3-/I(Q Registrar of Vital Statistics -
(s
./-. .
District Number �5a Place V.J(c20� (j JCS�-(. % J5 . 1()
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
i Date of Disposition `7 I i I I t Place of Disposition fia,V_r ST 4a-^
(address)
tucten) 024n mberr) (grave number)
Name of Sexton or Person in Charge of Premises A r'.iT'
z (pr ise punt)
Signature /�,--- Title t '
Viit
(over)
DOH-1555(02/2004)