Latterell, Hubert NEW YORK S'tATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Z Name First Middle Last I Sex
x Hubert Eugene Latterell Male
--11 Date of Death Age If Veteran of U.S. Armed Forces,
December 27, 2015 81 War or Dates
Place of Death Hospital, Institution or
ui City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death u Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Lit
Circumstances Investigation!,
W' Medical Certifier Name Title
Sean Bain, M.D. Dr.
E Address
100 park St. Glens Falls, NY 12801
Death Certificate Filed District Number Register Itumber
City, Town or Village 5601
❑Burial Date Cemetery or Crematory I
December 29, 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
❑Transportation Shipment
0? by Common Destination
G1 Carrier
- El 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
1- Remains are Shipped, If Other than Above
- Address
▪ .3 Permission is hereby granted to dispose of the human remains des ibb d b e ay icated.
9 '��r/ A G
▪ Date Issued ��29/24/S Registrar of Vital Statistics
_ (signature)
▪ `'': District Number 5601 Place �� ���, /t)y /Z60/
I certify that the remains of the.decedent identified above were disposed of in pccordanpe with this permit on:
W Date of Disposition F 5 Place of Disposition Quaker Road Queensbury,NY t2804
" '; (address)
Ut
C
=t (section) (lot number) (grave number)
50
Name of Sexton r Per on i Charge of Premises J t. i�rt &d o-te -
Z (please print)
Signature Title Gte- e;
(over)
DOH-1555 (02/2004)