Manell Sr, Ronald NEW YORK STATE DEPARTMENT OF HEALTH t Burial - Transit Permit
Records Section
Name First Middle Last - Sex
Ronald F. Manell Sr. Male
Date of Death y Age I If Veteran of U.S.Armed Forces,
I. May 18, 2016 I 69 War or Dates Vietnam
Z Place of Death Hospital,Institution or
W City,Town,or Village Glens Falls Street Address Glens Falls Hospital
o Manner of Death LI Natural Cause ❑Accident n Homicide 0Suicide 0 Undetermined 0 Pending
W Circumstances Investigation
0 Medical Certifier Name Title
0 Address
3 1 ronna.4--e.. CLyaso.. GUMS Fails, NV )LYa)
Death Certificate Filed District Number 1 Register Numr.
City,Town or Village Glens Falls 5 6 0) 'z6 7
❑Burial Date Cemetery or Crematory
May 25, 2016 Pineview Crematorium
n Entombment Address
is El Cremation 21 Quaker Road Queensbury, NY 12804
Date Place Removed
0 Q Removal and/or Held
- and/or Address
I' Hold
14 Date Point of
0 0 Transportation Shipment
L by Common Destination
Carrier
Date Cemetery Address
a EI Disinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home, Inc. 00885
Address
46 Williams Street, Whitehall, New York 12887
Name of Funeral Firm Making Disposition or to Whom
et Remains are Shipped, If Other than Above
W Address
O.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 5 ) 2 i-1 I( 6 Registrar of Vital Statistics (N ( A4-1/N-4 Vl%s✓\.c
(signature)
District Number 5 C7c1 f Place Glens Falls,New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 05/25/2016 Place of Disposition Pineview Crematorium
2 (address)
0
0 (section) lat number) (grave number)
O Name of Sexton or Person in Charge of Premises - D„�if
g �p lLe print)
�y `r'
W (P P )
Signaturea 4
Title f l t fit-
(over)
DOH-1555 (02/2004)