Borden Jr, Francis NEW YORK STATE DEr ' T OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Francis Edward Borden Jr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
1/3/2014 61 War or Dates
Place of Death Hospital, Institution or Westchester Medical Center
Town of Mt. 'Pleasant
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W City,Town or Village Street Address Valhalla, New York 10595
cg Manner of Death®Natural Cause ❑Accident Homicide Suicide Undetermined Pending
Uii Circumstances Investigation
W Medical Certifier Name Title
p Jared Nesbitt MD
Address
Ni
Westchester Medical Center, Valhalla, New York 10595
Death Certificate Filed Town of Mt. Pleasant District Number 5957 Register Number
City,Town or Village 16
❑Burial Date Cemetery or Crematory
1/9/14 Pine View Crematory
:,]•::i;i []Entombment Address
®Cremation Queansbury, NY
Date Place Removed
Z Removal and/or Held
2❑and/or Address
t: Hold
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0 Date Point of
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Q Transportation Shipment
ct by Common Destination
Carrier
El Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
1 IDpiii Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home Inc. 00885
Address
46 William Street, Whitehall, NY 12887 •
lii Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
Ill
n` Permission is hereby granted to dispose of the human remains scribed above as indicate .
Date Issued 1/7/14 Registrar of Vital Statistics 1;;;€,DL+c.c.co
(sig ure)
District Number 5957 Place One Town Hall Plaza, Valhalla, New York 10595
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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IW Date of Disposition i/1/ly Place of Disposition 1un6'o« i � or,,,,
(address)
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Cc (section) (lot number) (grave number)
• Name of Sexton or Pers n in Charge f Premises /hr„i r `)int. +
(pl ase print)
1! Signature Title CarAffitL
• (over)