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Gray Sr, Joseph NEW YORK STATE DEPARTMENT OF HEALTH , - % 77 tfl' Vital Records Section Burial - Transit Permit Name First Middle Last Sex Joseph Edward Gray Sr. Male Date of Death Age If Veteran of U.S. Armed Forces, March 29, 2016 79 War or Dates F Place of Death Hospital, Institution or W City, Town or (llage South Glens Falls Street Address 18 Riverview Street, Apt 123 W` Manner of De- ❑ ❑ ❑ ❑ Undetermined ❑ Pending © Natural Cause Accident Homicide Suicide Circumstances Investigation 0 Medical Certifier Name Title d Gerald F Abess MD, Address 3 Irongate Ctr. Glens Falls, NY 12801 Death Certificate Filed District Number Register Number City, Town or Village Burial Date Cemetery or Crematory7. 0 March 29, 2016 /'f)e 1 iea) L�'ea-*� �"5 ❑Entombment Address ' ®Cremation be e.fin 5 b ur`�J /tL . Date Place RemoVed/ // z ❑ Removal and/or Held Q and/or Address H Hold 0) Date Point of 0 Transportation Shipment to by Common Destination I Carrier Date Cemetery Address El Disinterment Date Cemetery Address El Reinterment 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 Address it Ui 11" Permission is hereby granted to dispose of the human remains de ribed above as Indic ted. Date Issued f Registrar of Vital Statistics / 6//ia ✓ t t� � Y�° (signs u ) ��, /�/ District Number Place - % Q `(_C�/� • I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 03/29/2016 Place of Disposition ,1J � t1-U'�' '. (address) Ui 0 re (section) 11 r°t yui ber) � (grave number) 0 Name of Sexton or Person in C rge of Premises (ple se print) �,�/� U),- Signature Title C�4Y1i1 (over) DOH-1555 (02/2004)