Snell, Riley NEW YORK STATE DEPARTMENT OF HEALTH ' w 4 t Kif
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Riley E. Snell Male
Date of Death Age If Veteran of U.S. Armed Forces,
October 29, 2014 77 War or Dates
Place of Death Hospital, Institution or
r City, Town or Village Glens Falls Street Address Glens Falls Hospital
s Manner of Death rrl
Natural Cause El Accident ❑ Homicide El Suicide ❑ Undetermined ❑ Pending
Jr, Circumstances Investigation
Medical Certifier Name Title
0, Frank Westad NP-L,
Address
'``" 1134 State Route 29 Greenwich, NY 12834
n: Death Certificate Filed District Number Register Number L1gg- y City, Town or Village Glens Falls
Burial Date Cemetery or Crematory
''❑ October 30, 2014 Pine View Crematory
14
❑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
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
El Reinterment
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home 01077
Address
123 Main St., Argyle NY 12809
4 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 10 i 3 0 i 1 L/ Registrar of Vital Statistics (3Q j n
(signature)
District Number 5 6 0 / Place 6 Cpns rct 115 cv y
-F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 10/30/2014 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) (lot number) \, (grave number)
( h1'•:To J".txt
Name of Sexton or Person in Char a of Premises . (�'
(pleasb print)
Signature L Title I''�l, r't/^ 62
9
(over)
DOH-1555 (02/2004)