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Austin, Walter NEW YORK STATE DEPARTMENT OF HEALT -I - Vital Records Section Burial - Transit Permit Name First Middle Last Sex Walter Nelson Austin Male Date of Death Age If Veteran of U.S. Armed Forces, January 12, 2016 85 War or Dates Place of Death Hospital, Institution or W City, Town or Village Glens Falls Street Address Glens Falls Hospital W' Manner of Death Natural Cause n Accident n Homicide E Suicide n Undetermined ri Pending Circumstances Investigation W Medical Certifier Name Title Suzanne Rayeski, D.O. Address 170 Warren Street Glens Falls, NY 12801 Death Certificate Filed District Number t Register) u ber City, Town or Village 1 Q11 ❑Burial Date Cemetery or Crematory January 18, 2016 Pine View Crematorium 0 Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z f Removal and/or Held L— and/or Address Hold Date Point of nTransportation Shipment 0): by Common Destination 0 Carrier Date Cemetery Address n Disinterment nReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom I— Remains are Shipped, If Other than Above 2' Address CL W' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued I I b Registrar of Vital Statistics �\.)e.A.A j., (sign'�V District Number 5 L-,0 I Place 6 (Q s CA 1 , s v I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I-= W Date of Disposition 01/18/2016 Place of Disposition Quaker Road Queensbury,NY 12804 (address) 1.1], Cl? (section) / (lot number) (grave number) pName of Sexton or Person in Charg of Premises �hnd �- lLrv���l (please print) W Signature Title � t (over) DOH-1555 (02/2004)