Hammitt, Hugh NEW YORK STATE DEPARTMENT OF HEALTH �31
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Hugh Taylor Hammitt Male
Date of Death Age If Veteran of U.S. Armed Forces,
November 28, 2012 68 War or Dates
Z Place of Death Hospital, Institution or
i
Cty, Town or Village Glens Falls Street Address Glens Falls Hospital
0- Manner of Death Natural Cause L=1 Accident El Homicide 0 Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
O John Sawyer, MD,
Address
453 Dixon Rd Queensbury, NY 12804
Death Certificate Filed District Number Register Number
City,City, Town or Village 5 .5
❑Burial Date Cemetery or Crematory
December 5, 2012 Pine Vew Crematorium
❑Entombment Address
®Cremation Queensbury,NY 12804
Date Place Removed
Removal and/or Held
and/or Address
Hold
Cri Date Point of
p, ❑Transportation Shipment
0, by Common Destination
O Carrier
Disinterment Date Cemetery Address
ElReinterment 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
1, Remains are Shipped, If Other than Above
2 Address
Ili
CL. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued )-MI I-1 1 / 2 Registrar of Vital Statistics LA) C 4-v-' (.4)..A...),--cOk5ZY
1 (signature)
District Number 560 ( Place 6LQj,•-.s ' i ` St A) y
I certify that the remains of the decedent identified above were disposed of in accordance/' with this permit on:
uDate of Disposition i t- C-I1 Place of Disposition -tUL J (,r•AT'ort'
2' (address)
Lli
Ce Ce (section) h (lot number) �, �
(grave number)
a Name of Sexton or Pe son in Charge of Premises [[[[ co '"'°
lease print)
W° Signature Title Ott iwerroi
(over)
DOH-1555 (02/2004)