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Mulvey, Paul NEW YORK STATE DEPARTMENT OF HEAL1TH 0 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Paul Thomas Mulvey Male Date of Death Age If Veteran of U.S. Armed Forces, November 4, 2015 54 War or Dates ZPlace of Death Hospital, Institution or W City, Town or Village Hudson Falls Street Address 18 Elizabeth Street Upper Manner of Death Natural Cause ❑ Accident ri Homicide Suicide ❑ Undetermined ❑ Pending Circumstances Investigation U W Medical Certifier Name Title O Dr. Paul R Philion, Address Irongate family Practice Assoc Glens Falls, NY Death Certificate Filed District Number Register Number City, Town or Village S 7 02 G /y ❑Burial Date Cemetery or Crematory November 6, 2015 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed • z r---1 Removal and/or Held O I I and/or Address Hold Date Point of a. _ Transportation Shipment CO — by Common Destination C) 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 I— Remains are Shipped, If Other than Above 2 Address OC W Q' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued /6 /6 id-a,/ - Registrar of Vital Statistics er ' --' � "(signature) District Number 5- )J/ Place Vi//4� 6I /c✓Scn f (is I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: N W Date of Disposition 11/06/2015 Place of Disposition Quaker Road Queensbury,NY 12804 2 (address) W Ie (section) (lot number) (grave number) pName of Sexton or Person in Charge of Premises -- ' v p ifv rt(tl/e z �.► � (please print) W Signature ��� Title Cec.•�a��. ols54 (over) DOH-1555 (02/2004)