Brown, Craig NEW YORK STATE DEPARTMENT OF HEALTH ` 3g)
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Craig Roy Brown Male
Date of Death Age If Veteran of U.S. Armed Forces,
June 15, 2014 60 War or Dates
Place of Death Hospital, Institution or
W City, Town or Village Whitehall Street Address 115 S. William Street
WManner of Death 0 Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
U Medical Certifier Name Title
Philip Gara, M.D. Dr.
Address
Broadway Fort Edward, NY 12828
Death Certific led District Number Register Number
f
City, Town o Villag W� 1leha,1 1 0 lc g
❑Burial Dafe Cemetery or Crematory 1
June 18, 2014 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
Removal and/or Held
and/or Address
H Hold
Date Point of
❑Transportation Shipment
Cl) by Common Destination
Carrier
Date Cemetery Address
El Disinterment
❑ Reinterment 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
t Remains are Shipped, If Other than Above
2 Address
CC
a. Permission is hereby granted to dispose of the human r ains described above as indicated.
/
Date Issued l0//"7//'/ Registrar of Vital Statistics U' l:Y',Cj,
p (signature)
District Number 57& Place 1,0h14thCO� Nebt) l'Drk
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 06/18/2014 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises itv,114& Sr++v�Z
(plprint)
W' Signature / Title cwl4
(over)
DOH-1555 (02/2004)