Dorvee, John I.
NEW YORK STATE DEPARTMENT OF HEALTH y w ° I 2-1
Vital Records Section Burial - Transit Permit
i Name First Middle Last Sex
P,Tt�. John R. Dorvee Male
Date of Death Age If Veteran of U.S. Armed Forces,
February 24, 2015 84 War or Dates /'3 6 a - 1 y Sy
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death J Natural Cause ❑ Accident [l Homicide 0 Suicide ❑ Undetermined ri 1--I Pending
CircumstancesInvestigation
. Medical Certifier Name Title
Christopher D. Hoy, M.D. Dr.
Address
44 102 Park St. Glens Falls, NY 12801
Death Certificate Filed District Number tt Register Number
City, Town or Village Glens Falls 5 60 f 1 0 `-(
❑Burial Date Cemetery or Crematory
February 26, 2015 Pine View Crematory
:❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
F❑ Removal and/or Held
and/or Address
Hold
Date Point of
❑Transn^rtat!t:n Shipment
by Common Destination
Carrier
f
Date Cemetery Address
-;; Disinterment
IA
,, ❑ Reinterment Date Cemetery Address
., - 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
'11 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.
Date Issued 21 26 I i 5 Registrar of Vital Statistics CAA41- - W-A"`-c
(signature)
frit District Number 5-6 1 Place 6 Ur-5 . \\ S 1 P L'
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 02/26/2015 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
a (section) /[ (lot number) (grave number)
Name of Sexton or Person in Charge of Premises "'w 'r, J;'i'"ift
/ftL (please print)
Signature Title «oopt
(over)
DOH-1555 (02/2004)