Dewey, Gregory NEW YORK STATE DEPARTMENT OF HEALTH
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Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Gregory Alan _ Dewey Male
• �} Date of Death Age If Veteran of U.S. Armed Forces,
January 18, 2016 47 War or Dates
Place of Death Hospital, Institution or
A City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death X❑ Natural Cause ❑ Accident ❑ Homicide ❑ Suicide 1-1 Undetermined ❑ Pending
t
Circumstances Investigation
Medical Certifier Name Title
' Paul F. Bachman, ME
Address
Warrensburg, NY 12885
'4` Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls Deo I 30
0 Burial Date Cemetery or Crematory
January 20, 2016 Pine View Crematory
: ❑Entombment Address
; ®Cremation Quaker Road Queensbury,NY 12804
0,, Date Place Removed
❑ Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
P Carrier
❑ Disinterment Date Cemetery Address
Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
;(. Name of Funeral Home M. B. Kilmer Funeral Home-Argyle 01077
M Address
4 123 Main St., Argyle NY 12809
r ' Name of Funeral Firm Making Disposition or to Whom
„.< Remains are Shipped, If Other than Above
• Address
1
w.
Permission is hereby granted to dispose of the human remains de cr be a vezwZ cated.
Date Issued ('/f z o/Zo/t, Registrar of Vital Statistics
r (signature)
District Number 3 C>O� Place G��° /- 1�5, N)
. ...
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 01/20/2016 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) /��(lot number) (grave number)
Name of Sexton or Person in Charg of Premises l f'r-}c,�-- &,,+u.61"
7 (please print)
Signature (.�- ii1 Title I111Z,
(over)
DOH-1555 (02/2004)