Hanchett, Allyn NEW YORK STATE DEPARTMENT OF HEALTH # 9 Z
Vital Records Section Burial - Transit Permit
: ' Name First Middle Last Sex
Allyn Fred Hanchett Male
Date of Death Age If Veteran of U.S. Armed Forces,
February 11, 2012 90 War or Dates
-~ Place of Death Hospital, Institution or
q City, Town or Village South Glens Falls Street Address 9 McHugh Street
Manner of Death X❑ Natural Cause ❑ Accident 0 Homicide ❑ Suicide 0 Undetermined ❑ Pending
4. Circumstances Investigation
Medical Certifier Name Title
` John P. Stoutenburg, M.D. Dr.
Address
102 Park Street Glens Falls, NY 12801
, Death Certificate Filed District Number Register Number
City, Town or Village
❑Burial Date Cemetery or Crematory
February 14, 2012 Pine View Cemetery
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
and/or Address
Hold
Date Point of
- ❑Transportation Shipment
by Common Destination
Carrier
M1 ❑ Disinterment Date Cemetery Address
s- ❑ 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 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 rema s described above as indicated.
-- r P/ /a Registrar of Vital Statistics
Date Issued � 9 ,(�a/9 C) o.-2 ,eg..e9<'��
(signature)
District Number 5 a 4 Place 1``/Cup OF .0 JJI L CI 1 ��
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 02/14/2012 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
v (section) A (lot number) (grave number)
4 Name of Sexton or Per, n in Charge Premises ar•a4 T .,,-ii+
(please print)
.£ Si 9nature �. Title �'�EMF�t
(over)
-1555 (02/2004)