Ludin, John s z
NEW YORK STATE DEPARTMENT OF HEALTH �
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
John T. Ludin Male
Date of Death I Age If Veteran of U.S. Armed Forces,
January 13,2012 1 49 War or Dates
1_, Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
1p Manner of Death I XI Natural Cause I Accident I I Homicide Suicide Undetermined I 1 Pending
Circumstances Investigation
Gw Medical Certifier Name Title
Paul F Bachman MD
Address
3767 Main Street,Warrensburg,NY 12885
Death Certificate Filed District Number Regi,ster,Number
City, Town or Village Glens Falls 5601 4.
❑Burial Date 1 Cemetery or Crematory
❑Entombment January 13, 2012 j Pine View Crematorium
Address
It Cremation 21 Quaker Road,Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
2 and/or Address
N Hold
0 Date Point of
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u) Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
ri Reinterment Date ; Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton-Healy Funeral Home 01596
Address
407 Bay Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
1- Remains are Shipped, If Other than Above
E Address
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Q., Permission is hereby granted to dispose of the human remains descr' ed a ov as i ted.
Date Issued 47�20/1 Registrar of Vital Statistics 4c ,
signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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w Date of Disposition 1/I9 /i 2 Place of Disposition ,,,,Q V ;n-iipeiI
W (address)
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(section) (lot num ) (grave number)
Q Name of Sexton or Perso in Charge of remises 4r,citviiii" p40
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W AL Title (.712.e }tk_
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(over)
DOH-1555(02/2004)