Tuttle, George NEW YORK STATE DEPARTMENT OF HEALTH ggg
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
George V.W. Tuttle Male
Date of Death Age If Veteran of U.S. Armed Forces,
Dec. 14, 2015 69 yrs. War or Dates Navy
1- Place of Death Hospital, Institution or
X City, Town or Village Fort Ann Street Address 30 Atkinson Lane
a Manner of Death Natural Cause 0 Accident 0 Homicide 0 Suicide Undetermined Pending
txt Circumstances Investigation
W Medical Certifier Name Title
0 Ccralredss Abcss MD.
3 Iron gate Ctr. , Glens Falls, NY. 12801
Death Certificate Filed District Number Register Number
City, Town or Village Fort Ann --47,1r0 i7
OBurial Date Cemetery or Crematory
Dec. 16, 2015 PineView Crematorium
❑Entombment Address
Cremation Queensbury, NY. 12.804
Date " ice Removed
Z Removal _ d/or Held
and/or Address
F Hold
t13 _ ._
Date Point of
it 0
Transportation j Shipment
0 by Common Destination
Carrier
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Mason Funeral Home Registration Number
Cl Name of Funeral Home 011 1 7
Address
P.O. Box 277, Fort Ann, NY. 12827
ql Name of Funeral Firm Making Disposition or to Whom
fI Remains are Shipped, If Other than Above
2 Address
t
tit
� Permission is hereby granted to dispose of the humaw/cains described abo s i dicated.
igiii Date Issued 1 2/1 5/1 5 Registrar of Vital tatistics G ii
sd-
(signature)
tr
District Number ,5'7.$-� Place n9jv , / 91 0 7
'> I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
al Date of Disposition 12-1<<-i 7 Place of Disposition P,`n e i't.J G/'e,r+,ie r
a (addre s)
Ul
CC (section) ` (lot number) (grave number)
C} Name of Sexton r Perso in Charge of Premises �J�it k.h 64,-,e14.
Z (please print)
Signature Title Cry 471ory Q,53•23-11 .t-
(over)
DOH-1555 (02/2004)