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Gonyeau, John NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section t, Burial - Transit Permit ,E E< Name First Middle Last Sex John Howard Gonyeau Male F°, Date of Death Age If Veteran of U.S. Armed Forces, July 2, 2016 89 War or Dates World War II I-" Place of Death Hospital, Institution or WCity, Town or Village Kingsbury Street Address 3646 Burgoyne Avenue W Manner of Death❑Natural Cause ❑ Accident ❑ Homicide ❑ Suicide 0 Undetermined Pending , Circumstances Investigation Ui Medical Certifier Name Title ; „ Address Death Certificate Filed District Number Register Number City, Town or Village c 7 6 .Z (1 ❑Burial Date Cemetery or Crematory Pine Vew Crematorium s❑Entombment Address ©Cremation Queensbury,NY 12804 Date Place Removed Removal and/or Held and/or Address p Hold VT Date Point of d ❑Transportation Shipment by Common Destination w Carrier Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 't , Address J 3 Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above ``. Address LLB .. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued -S-„2 e/L Registrar of Vital Statistics Gam,,y /; (signature) District Number 3-7 6,1 Place 70(4- 1 �i 4 I certify that the remains of the decedent identified above were disposed o in accordance with this permit on: tut Date of Disposition 7 1 ,01 16 Place of Disposition Queensbury,NY 12804 i (address) atifi (section) (lot num r) (grave number) a Name of Sexton or Person in Charge of Premises irt; it^"'ir ' : (please print) W Signature L / Titlefitesirr-PrZ (over) DOH-1555 (02/2004)