Menger, Steven 4 .
NEW YORK STATE DEPARTMENT OF HEALTHc`l7
Vital Records Section .,,, Burial - T ansit Permit
Name First Middle Last Sex
Steven J. Menger Male
Date of Death Age If Veteran of U.S. Armed Forces,
July 20, 2015 58 War or Dates
Place of Death Hospital, Institution or
w City, Town or Village Glens Falls Street Address Glens Falls Hospital
WManner of Death IL,im Natural Cause ❑ Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
David T. Slingerland, Dr.
Address
Broad Street Health Center Glens Falls, NY 12801
Death Certificate Filed District Number Register Number co
City, Town or Village 5601
Burial Date Cemetery or Crematory
July 27, 2015 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
Removal and/or Held
and/or Address
Hold
Date Point of
a. n Transportation Shipment
by Common Destination
CI Carrier
Disinterment Date Cemetery Address
Reinterment 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
Remains are Shipped, If Other than Above
• Address
- Permission is hereby granted to dispose of the human remains descri e a ov s i ted.
Issued Registrar of Vital Statistics G �
Date ssue �
(signature)
District Number 5601 Place
I certify that the remains of the decedent identified above xere disposed of in accordance with this permit on:
W Date of Disposition 07/27/2015 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
re (section) (lot number) (grave number)
g Name of Sexton or Person in Char a of Premises Fill o4ky1. n, ,1/(
�� � (please print)
ill Signature Title Crw,►,akorl fs5'
(over)
DOH-1555 (02/2004)