Downing, George •
NEW YORK STATE DEPARTMENT OF HEALTH l
Vital Records Section Burial - Transit Permit
'v4 y,✓ Name First Middle Last Sex Male
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;?�z George S. Downing
0 Date of Death Age If Veteran of U.S. Armed Forces,
a.' 04/18/2011 73 War or Dates 1961-1966
iiii Place of Death Hospital, Institution or
City. �+Ie ; Glens Falls Street Address Glens Falls Hospital
to Manner of Death(�Natural Cause ElAccident Homicide 0 Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Address
it
t Death Certificate Filed District Number —Register Number
City, Glens Falls J
Date Cemetery of Crematory
❑Burial 04/25/2011 1 Pine View Crematory
Address
®Cremation Queensbury,NY
Date I Place Removed
Zrl Removal i I and/or Held
= and/or Address
g
Hold
Date Point of
Q Transportation Shipment
5 by Common , Destination
Carrier
Disinterment Date ' Cemetery Address
Reinterment Date Cemetery Address
,
z,.t,
Permit Issued to I Registration Number
y Name of Funeral Home Brewer Funeral Home, Inc. ; 00205
Address
f 24 Church St, PO Box 500, Lake Luzerne, NY 12846
14 Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
k. Permission is hereby granted to dispose of the human remains described above as indicated.
N: Date Issued 14/2 / /I i Registrar of Vital Statistics -e.
% (signature)
i,�� District Number S 60 ) Place 6 ,\vs1 /
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
i-
6 Date of Disposition y-Z-t( Place of Disposition Fite 1),.c4.•• C+ Vfotii,,
X (address)
fa
to
G (section) �� (Iqt numb,er) (grave number)
Name of Sexton or Per on in Charge Premises r., hie r .10��.N
(please print)
1.0 Signature �� Title Ceti A4. pa.
DOH-1555 (10/89) p. 1 of 2 VS-61