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Bannon, Joseph 7 NEW YORK STATE DEPARTMENT OF HEALTH 1-0 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Joseph Edward Bannon Male ,5 Date of Death Age If Veteran of U.S. Armed Forces, December 26, 2015 59 War or Dates Place of Death Hospital, Institution or t. City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death 0 Natural Cause ❑ Accident Homicide 0 Suicide ❑ Undetermined 0 Pending ill Circumstances Investigation Medical Certifier Name Title 0 Dr. Sean Bain, .MD Address -,. ,:; FtensFnlilt Jury 124tini Death Certificate Filed District Number Register IXuber City, Bevan or Village cie,„ ,.1/s ?�6D/ Ur� Date Cemetery or Crematory Burial December 31, 2015 Pine View Crematorium El Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z ❑ Removal and/or Held and/or Address H Hold N Date Point of aEl Transportation Shipment to by Common Destination p Carrier - ElDisinterment 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 ; Remains are Shipped, If Other than Above 2' Address f III 11- Permission is hereby granted to dispose of the human remains descr' d a o as ' ated. Date Issued / 77fS Registrar of Vital Statistics ld _ (signature) District NumberG,O/ Place • /2►6/, /VY F I certify that the remains of the decedent identified above were disposedof in accordance with this permit on: z PP1 ry W Date of Disposition 12/31/2015 Place of Disposition Quaker Road Queensbury,NY 12804 j, (address) I1 Ce (section) (lot number) (grave number) aName of Sexton or Person in Charge of Premises -J P.1, r7 6t.r24a e-/e z (please print) W; Signature Title C r-e.-,-74/ '� (over) DOH-1555 (02/2004)