Dunne, Jason NEW YORK STATE DEPARTMENT OF HEALTH t 111. /t 15
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Jason P. Dunne Male
Date of Death Age If Veteran of U.S. Armed Forces,
March 3, 2014 54 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death X❑ Natural Cause ❑ Accident ElHomicide ElSuicide ❑ Undetermined ❑ Pending
Circumstances Investigation
Medical Certifier Name Title
Timothy Murphy,
Address
52 Haviland Ave Glens Falls, NY 12801
Death Certificate Filed District Number Register Numbe
City, Town or Village Glens Falls 5 b. 0/ 1 0 b
0 Burial Date Cemetery or Crematory
March 7, 2014 Pine View Crematory
❑Entombment Address
v ®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
❑ Disinterment Date Cemetery Address
ElReinterment 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 remains described above as indicated.
Date Issued 31 L/ t i' Registrar of Vital Statistics LAD ,C� .S2_ W-
(signature)
District Number 5 5Q 1 Place 6 (S v S fi-C1 ( 1 c / A! (7)
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 03/07/2014 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
IS
i (section) lot number) (grave number)
Name of Sexton or Pers in Char of Premises 4 s �'�"N
(p ase print)
Signature Title C 'rNt42
(over)
DOH-1555 (02/2004)