Loading...
Hveem Sr, Harvey r NEW YIRK STATE DEPARTMENT OF HEALTH Vital RecordsSection Burial - Transit Permit Name First Middle Last Sex Harvey Gene Hveem Sr. Male Date of Death Age If Veteran of U.S. Armed Forces, December 31, 2015 54 War or Dates F^ Place of Death Hospital, Institution or W' City, Town or Village Queensbury Street Address 13A Moose Hollow Way W Manner of Death 0 Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ri❑ Pending Circumstances Investigation W. Medical Certifier Name Title P Aqeel A. Gillani, M.D. Dr. Address 102 Park St Glens Falls, NY 12801 Death cate Filed District Number Register Number City own of Village ( lA-�-4 S.i i c`R El Buria Date Cemetery or Crematory January 4, 2016 Pine Vew Crematorium ❑Entombment Address ©Cremation Queensbury,NY 12804 Date Place Removed z ❑ Removal and/or Held and/or Address F. Hold (0 Date Point of 0. ❑Transportation Shipment 0) by Common Destination p Carrier Date Cemetery Address Ell Disinterment Date Cemetery Address El Reinterment 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 W- 0_ Permission is hereby granted to dispose of the human re s eScri e o indicated. Date Issued k 4�.p t(P Registrar of Vital Statistics 1 -0 ,c fj / (signature) District Number S� Place `/%ate, __ .------- - . I certify that the remains of the decedent identified above - - disposed of in accor.-nce wit this permit on: W` Date of Disposition 0 6 Place of Disposition s ueensbury,NY 12804 2 (address) W W (section) //(lot number) (grave number) 0' Name of Sexton or P rson in harge of Premises ��-�►�� C�4 �"�_ Z (pleaseprint) In Signature Title e-ev-,yte / ' (over) DOH-1555 (02/2004)