Aubin, Sr. Harry IL
NEW YORK STATE DEPARTMENT OF HEALTH F if 6'
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Harry J. Aubin, Sr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
I. June 18, 2011 66 War or Dates
Z Place of Death Hospital, Institution or
W City,Town,or Village Glens Falls Street Address 16 Steven St., (residence)
G Manner of Death 0 Natural Cause ❑ Accident ❑Homicide ❑Suicide ❑Undetermined ❑ Pending
W Circumstances Investigation
U Medical Certifier Name Title
0 Address .—• V
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls ( 2 7 q
E Burial Date Cemetery or Crematory
June 21, 2011 Pineview Crematorium
❑Entombment Address
0 Cremation Queensbury, New York
Z Date Place Removed
0 ❑Removal and/or Held
and/or Address
Hold
0 Date Point of
4 ❑Transportation Shipment
0. by Common Destination
Carrier
Date Cemetery Address
0 ❑Disinterment
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home, Inc. 00897
Address
46 Williams Street, Whitehall, New York 12887
~ Name of Funeral Firm Making Disposition or to Whom
X• 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 6 !2(v / ) Registrar of Vital Statistics W�W '
(signatur
District Number 5 6 0 ' Place Glens Falls,New York
H I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z n
W Date of Disposition Gilt I i( Place of Disposition �`ifsc0 C t&w4„,,„x-
2 (address)
W
N
0 (section) (lot numbe,.) (grave number)
0• Name of Sexton or Pers in Charge of P mises tir,J{ 1 rnnitt
W (please print)
Signature ✓ ��d'-h�S Title tQ EIn►4rUQ_
I (over)
DOH-1555 (02/2004)