Boyd, Paul It
NEW YORK STATE DEPARTMENT OF HEALTH ' l Z
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Paul Boyd I Male
Date of Death Age If Veteran of U.S. Armed Forces,
2-1 0-201 6 64 War or Dates YES
F . Place of Death City of Glens Falls Hospital, Institution or Glens Falls Hospital
City, Town or Village Street Address
ILIW▪ Manner of Death®Natural Cause 0 Accident 0 Homicide 0 Suicide Undetermined 0 Pending
Circumstances Investigation
ui Medical Certifier Name Title
CV Michael Miles MD
Add100 Park St. Glens Falls, New" York 12801
Death Certificate Filed District Number Register Number
City, Town or Village City of Glens Falls .5 60) -7 1
❑Burial Date Cemetery or Crematory
2-1a-2016 Pine View Crematory •
❑Entombment Address
ig®Cremation 21 Quaker Road Queensbury, New York 1 2804
Date Place Removed
Z r—i❑Removal and/or Held
9. and/or Address
H Hold
In
0 Date Point of
t" 0 Transportation • Shipment
Ca by Common Destination
gii Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
•
Permit Issued to Registration Number
Name of Funeral Home M M. B. Kilmer Funeral Home 01 0 7 8
Address
136 Main St. South Glens Falls, New York 12803
III Name of Funeral Firm Making Disposition or to Whom
. 14 Remains are Shipped, If Other than Above
Address
i
L
"' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 2-1 t-201 6 Registrar of Vital Statistics t%eti.A.,
(signature)
District Number stc ` Place City of Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
k � ,r
LU Date of Disposition Z fib/Ii. Place of Disposition 'f Iatlp rt,i (0,••00f$w
(address)
IEEE
CA
CC (section) l (lot number) (grave number)
ci Name of Sexton or Person in Charge of Premi s ��jr,, �`"�`
(pletise print)
114
Signature Title 62 "47n-
(over)
DOH-1555 (02/2004)