Gebo, Francis NEW YORK STATE DEPARTMENT OF HEALTH lt2, /
Vital Records Section I Burial - Transit Permit"
Name First Middle Last Sex
Francis J. Gebo Male
Date of Death If Veteran of U.S.Armed Forces,
July 25, 2012 Age76 War or Dates 1954-1956
Z Place of Death Hospital, Institution or 6�' F,,4 j(5 /ziDS :7�91!
W M
City,Town,or Village Castleton Street Address M. ' J 1••—r
0 Manner of Death ❑Natural Cause ®Accident 0 Homicide 0Suicide 0 Undetermined El Pending
W Circumstances Investigation
0 Medical Certifier Name Title
W Timothy Murphy Coroner
0 Address
52 Havilan Park Glens Falls New York 12801
Death Certificate Filed District Number„_ .O i Register Nurryper
City,Town or Village City of Glens Falls
❑Burial Date July30, 2012 Cemetery or Crematory
Pine View Crematory
❑Entombment Address
®Cremation 21 Quaker Road Queensbury New York 12803
Date Place Removed
0 0 Removal and/or Held
- and/or Address
I' Hold
0 Date Point of
4 0 Transportation Shipment
D.
by Common Destination
,� Carrier •
_ Date Cemetery Address
5 0 Disinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home, Inc. 00885
Address
46 Williams Street, Whitehall, New York 12887
~ Name of Funeral Firm Making Disposition or to Whom
2 Remains are Shipped, If Other than Above
CC
W Address
O.
Permission is hereby granted to dispose of the huma remains s. riibeQd above as ind' • - .
Date Issued 07��7 J 'Z Registrar of Vital Statistics C�'�"` a OZf1
(signature)
District Number L5Z0d/ Place .e_,�= J i o12�
I certifythat the remains of the decedent identified above were disp sed of in accordance with'this permit on:7
F
Z
W Date of Disposition ? • — /2 Place of Disposition Role Li ��-e ,..) Cr. v i Jar,'vw^
g (address)
W
0 t i(section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises jiiy 1 '(1ih e ik
_ _' / (please print)
W .h'vtic �y Signature Title Cf.,wigr7 _11551--
(over)
DOH-1555 (02/2004)