Viele, Charles NEW YORK STATE DEPARTMENT OF HEALTH r i 4 511
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Charles Lewis Viele Male
Date of Death Age If Veteran of U.S. Armed Forces,
08/05/2014 65 years War or Dates
}- Place of Death Hospital, Institution or
ILICity, Tow�p �1t/i Glens Falls Street Address
Manner of Death p Glens Falls Hospital
Natural Cause 0 Accident 0 Homicide Suicide ElUndetermined ri Pending
UCircumstances Investigation
!U Medical Certifier Name Title
Li Melissa Decker M D
Address
100 Park Street Glens Falls, Ny 12801
Death Certificate Filed District Number Register Number
City, ToWAXXX/iDEVXXX Glens Falls 5601 377
''El Burial Date Cemetery or Crematory
Entombment 08/06/2014 Pine View Crematorium
Address
: Cremation Queensbury, NY 12804
Date Place Removed
Removal and/or Held
C3 and/or
Address
C/
Hold
O Date Point of
11,16 0 Transportation Shipment
0 by Common Destination
Carrier
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home 01078
Address
136 Main Street South Glens Falls, N Y 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
1
fl"' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/06/2014 Registrar of Vital Statistics C."7
s,\PVC:4--
ign
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
k
tit Date of Disposition g h16(' Place of Disposition
✓ a v.ttor
t,__
2 (address)
0
CC (section) (lot number) (grave number)
el Name of Sexton or Person in Charge of Premises i41:$66e.., Ae40 4(p/ e print)
• Signature Title Ctift,w/tree
(over)
DOH-1555 (02/2004)