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Healey, Dennis
it -PI NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First iddle Last Sex Dennis Jose. . Healey Male Date of Death Age ; eteran of U.S. Armed Forces, October 22, 2016 76 ar or Dates I— c of Death Hospital, Institution or City, own or Village Glens Falls Street Address Glens Falls Hospital anner of Death L/LiNatural Cause El Accident ❑Homicide Suicide 0 Undetermined Pending Circumstances Investigation U W Medical Certifier Name Title Matthew Varughese, M.D. Dr. Address 100 Park Street Glens Falls, NY 12801 Certificate Filed District Number Register Number Ci own or Village (�I ,,,e-i 'S J" ct- 5601 5 '3 ^?❑Burial Date Cemetery or Crematory October 24, 2016 Pine View Crematorium 0 Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z Removal and/or Held • and/or Address F.: Hold CO Date Point of a ❑Transportation Shipment 3i by Common Destination • Carrier 0 Disinterment Date Cemetery Address 0 Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom H` Remains are Shipped, If Other than Above 2 Address .1 W'' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued I,U 1 --1-1 11(� Registrar of Vital Statistics W n k (signature District Number 5601 Place 6 (Q AS vom c, Uy I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: wDate of Disposition 10/24/2016 Place of Disposition Quaker Road Queensbury,NY 12804 al (address) Ce (section) (lot number) (grave number) ci Name of Sexton or Person in Charge of Premises afj �� Jt4.4//j" Z ,� ase print) al Signature 4 / *� ( leTitle (PE Matt- (over) DOH-1555 (02/2004)