Navarro, Louis NEW YORK STATE DEPARTMENT OF HEALTH viiii I/ (7 I
Vital Records Section Burial - Transit Permit
77' Name First Middle Last Sex
Louis Anthony Navarro Male
Date of Death Age If Veteran of U.S.Armed Forces,
March 9, 2015 65 War or Dates
Place of Death Hospital, Institution or
w City, Town or Village Glens Falls Street Address Glens Falls Hospital
CI: Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending
0.
Circumstances Investigation
ilk Medical Certifier Name Title
CI John Stoutenbura, M.D. Dr.
,, Address
102 Park Street Glens Falls, NY 12801
Death Certificate Filed District Number Register I)l �er
°-' City, Town or Village 5601
0 Burial Date Cemetery or Crematory
March 10, 2015 Pine View Crematorium
k '0 Entombment
�� Address
®Cremation Quaker Road Queensbury,NY 12804
it Date Place Removed
2,in Removal and/or Held
and/or Address
Hold
Date Point of
704❑Transportation Shipment
by Common Destination
Carrier
Date Cemetery Address
Disinterment
Reinterment Date Cemetery Address
CI
;, 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
°x Remains are Shipped, If Other than Above
Address
1.
'
i-911 Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 3 i l l) f)S Registrar of Vital Statistics W C& l` -`z U
(sign Lure)
District Number 5601 Place 6r.S \X5 / tu
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I (add03/10/2015 Date of;, DispositionPlace of Disposition Quaker Road Queensbury,NY 12804
4
ress)
(section) (lot number (grave number)
!gi
Name of Sexton or Person in Charge of Premises 4-clatior- 364.44
(please print)
W£' Signature
"4Title moirra,
(over)
DOH-1555 (02/2004)