Caprood Sr, Carl NEW YORK STATE DEPARTMENT OF HEALTH W 7/
Vital Records Section Burial - Transit Permit
y „, Name First Middle Last Sex
Carl J. Caprood Sr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
April 17, 2015 64 War or Dates Vietnam
• Plac- --!-ath + Hospital, Institution or
t Ci Town or Village £ (ir v t' 1'e-- Street Address The Orchard Nursing Home
It Manner of Death X❑ Natural Cause El Accident ❑ Homicide ❑ Suicide ❑ Undetermined n Pending
Circumstances Investigation
Medical Certifier —Name ��` T tl
t� �s b
Mal . 4D 6Q iUdl(e rzc.
'4.01Death - ificate File District NiGmber Register Number
� Ci ow or Village
t� 5r151a g 1 O
4 ❑Burial Date Cemetery or Crematory
April 20, 2015 Pine View Crematory
• ❑Entombment Address
• ®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
and/or Address
Hold
Date Point of
_ 0 Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
s` Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078
Address
136 Main Street, South Glens Falls NY 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
M Date Issued 4120 I l 5 Registrar of Vital Statistics ct-,
ignature)
District Number 596E Place 'Tpt, r,) ���� i v
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
#7. Date of Disposition 04/20/2015 Place of Disposition Quaker Road Queensbury,NY 12804
' (address)
(section) lot number) (grave number)
Name of Sexton or Person in Charge of Premises An -5i, ,..
(ple se print)
Signature �"' .�� Title rail`kint
(over)
DOH-1555 (02/2004)