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Combs, Alan NEW YORK STATE DEPARTMENT OF HEALTH, le* # 30 4 , Vital Records Section Burial - Transit Permit Name First Middle ' Last Sex Alan T Combs Male Date of Death Age If Veteran of U.S.Armed Forces, I. April 18, 2016 66 War or Dates / '- / 417 / 2 Place ath Hospital, Institution or W City Town,or Village Whitehall Street Address Home 3,. /4-bic_c__./2 Pc ki ck G Manner of Death ©Natural Cause El Accident L=I Homicide El Suicide 0 Undetermined El Pending W Circumstances Investigation G Medical Certifier Name Title W Mrs. Ruth Scribner Coroner Q Address Whitehall, NY 12887 Death Certificate Filed District Number Register Number City,Town or Village Whitehall 510 1P a.. ❑Burial Date Cemetery or Crematory April 22, 2016 Pineview Crematorium ❑Entombment Address IDCremation 21 Quaker Road Queensbury, NY 12804 IC Date Place Removed 0 Ei Removal and/or Held - and/or Address F. Hold 16 Date Point of 4 El Transportation Shipment d by Common Destination i Carrier Date Cemetery Address aDisinterment Renterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Jillson Funeral Home, Inc. 00885 Address 46 Williams Street, Whitehall, New York 12887 I— Name of Funeral Firm Making Disposition or to Whom ix ix Remains are Shipped, If Other than Above W Address 0. Permission is hereby granted to dispose of the human remains described above as indicated.1 Date Issued L '•2-1 wiD I(0 Registrar of Vital Statistics (-- 0 (signature) •�7 District Number 5 1 ( 1, Place Whitehall,New York F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 2 W Date of Disposition 04/22/2016 Place of Disposition Pineview Crematorium 2 (address) W 0 (section) lot number) (grave number) d Name of Sexton or Person in Charge of Premises � ,�(awls' 2 �??pp (p ase print) tls1 W Signature CrC_ Title ir<t•✓2. (over) DOH-1555 (02/2004)