Loading...
Conklin, Abel # 2t / NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit ��" "'M'11" Vital Records Sectiona s e' Name First Middle Last i Sex Abel Rae Conklin Male Date of Death A 9 e I If Veteran of U.S. Armed Fo rces, orces, 04/03/2016 1 Stillborn i War or Dates I. Place of Death i Hospital, Institution or Z City,'7 ti XYAI J ()< Glens Falls Street Address Glens Falls Hospital Manner of Death 0 Natural Cause [l Accident 0 Homicide 0 Suicide ©Undetermined ri Pending QCircumstances - Investigation W Medical Certifier Name Title Gt Allison Herrick CEO Address 45 Hudson Ave, Glens Falls NY 12801 Death Certificate Filed District Number Regis umber 3 r City, atOsOltl a Glens Falls WQ [Burial Date Cemetery or Crematory 04/06/2016 Pine View Crematorium ©Entombment Address OCremation Quaker Rd, Queensbury, NY 12804 Date Place Removed Removal and/or Held 0 and/or f,,,, Address -- Hold Date Point of A El Transportation Shipment G by Common Destination Carrier []Disinterment Date Cemetery Address 0 Rein#erment Date Cemetery Address c. Permit Issued to ' Registration Number : Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address 68 Main St. Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom F» Remains are Shipped, If Other than Above a Address cr tU Cl.. Permission is hereb granted to dispose of the human remains describ a ov as ' ed. Date Issued ey Q% za.Registrar of Vital Statistics `� (signature) District Number a 6,0/ Place Ch /rat lh , Ai F-+ I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: iii Date of Disposition A/.7 tt, Place of Disposition )' �, e Gr`e641 r W (address) Cl) Ix (section) (lot number 1 /' J (grave number) C Name of Sexton Ch rge of Premises - l ra./< kt (9f�,wi e 2 (please print) Signature Title G^re/►'i4' (over) DOH-1555 (02/2004)