Greene, Ronald NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Ronald J. Greene Male
:r' .� Date of Death Age If Veteran of U.S. Armed Forces,
;;;:, June 1, 2015 64 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls, NY Street Address Glens Falls Hospital
O M• anner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
ttiCircumstances Investigation
I M• edical Certifier Name Title
Robert Beaty Dr.
Address
100 Broad Street,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
:X City, Town or Village 560 I 'L,g',
❑Burial Date Cemetery or Crematory
[I]Entombment June 3, 2015 Pine View Crematorium
Address
I Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
to
O Date Point of
NTransportation Shipment
p by Common Destination
_Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
:;: Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
i'`:: Remains are Shipped, If Other than Above
Address
IX
Permission is` hereby granted to dispose of the human remains described above as indicated.
Date Issued 6 J f
3 Registrar of Vital Statistics v'N 1
(signatu )
X District Number 5 60) Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition L (S/„r- Place of Disposition Z 14., C
2 (address)
w
co
O (section) (lot numb ) (grave number)
Z Name of Sexton or Person in Charge of Premises f.4 1nI6L'
Ili
(please print)
Signature 14 Title l y1K
(over)
DOH-1555(02/2004)