Loading...
Hayes, Ray NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit 1 Vital Records Section Name First Middle Last Sex Ray Hayes Male Date of Death Age If Veteran of U.S. Armed Forces, 07/21/2011 85 War or Dates World War II Place of Death Hospital, Institution or W City, Town or Village GLENS FALLS Street Address GLENS FALLS HOSPITAL W Manner of Death J Natural Cause Ell Accident ❑ Homicide El Suicide ❑ Undetermined ❑ Pending L.) Circumstances Investigation WW Medical Certifier Name �le Daniel Way, Address North Creek Health Center North Creek, NY 12853 Death Certificate Filed G I /3 / is/i DistrictNumber, Register Number City, Town or Village l /(a U {f 6- 3 0 Burial Date Cemetery or Crematory El Entombment 07/22/2011 PINE VIEW CREMATORY Address all-e&044/137© 7 J� G©Cremation QUAKER RD ODate ved z I—I Removal and/or Held p 1 I and/or Address E Hold Date Point of il ❑Transportation Shipment GO by Common Destination a Carrier Date Cemetery Address ❑ Disinterment Date Cemetery Address ❑ Reinterment Permit Issued to Registration Number Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00141 Address 9 Pine St/P.O. Box 455 Chestertown NY 12817 Name of Funeral Firm Making Disposition or to Whom I— Remains are Shipped, If Other than Above 2 Address W a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued ./ 2ZJ! / Registrar of Vital Statistics Ct.,t (./ (signature) District Number 560 t Place fj kszA^S F-et1ks( N H I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition )ITS hi Place of Disposition fL P P (Lk-)i..." C.,ttin.-4o r,�- W2. (address) CO Ce (section) (lot num (grave number) 0 C Name of Sexton or P on in Charge f Premises �ti �-- CinNIf Z (please print) W Signature Title CQ 4-1,ur= (over) DOH-1555(02/2004)