Paton, R NEW YORK STATE DEPARTMENT OF HEALTH # /°
Vital Records Section Burial - Transit Permit
Name First ~Middle Last Sex
R. Douglas "Doug" Paton Male
Date of Death Age If Veteran of U.S. Armed Forces,
4 June 8, 2015 78 War or Dates
Place of Death •1-lospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death u Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
_' Medical Certifier Name Title .
Paul F. Bachman,
Address
3767 Main Street Warrensburg, NY 12885
Death Certificate Filed District Number Register Number
Ci Town or Village Glens Falls o0
❑Burial Date Cemetery or Crematory
June 10, 2015 Pine View Crematory
°' ❑Entombment Address
ti®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
, and/or Address
Hold
Date Point of
ry -❑Transportation Shipment
by Common Destination
j Carrier
Date Cemetery Address
❑ Disinterment
ir ElReinterment Date Cemetery Address
it Permit Issued to Registration Number
s Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078
u..
7 Address
136 Main Street, South Glens Falls NY 12803
Name of Funeral Firm Making Disposition or to Whom
ma. Remains are Shipped, If Other than Above
' Address
,
rA Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 0 c 0 1 15 Registrar of Vital Statistics (.)cLAi.yO UL.).�
(signature
District Number 5 60 1 Place 6 Fa 11 S ,
`, I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 06/10/2015 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises (',) Stinnett
(p ase print)
Signature4. Title i'1Th .
(over)
DOH-1555 (02/2004)