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Carey, Joel NEW YORK STATE DEPARTMENT OF HEALTH .- `- � � it r'=-= 7 ott Vital Records Section Burial - Transi Permit Name First Middle Last Sex Joel F. Carey Male ;,rf f Date of Death Age If Veteran of U.S. Armed Forces, ff June 2, 2012 62 War or Dates '= Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death j Natural Cause ❑Accident ❑Homicide I 1 Suicide ❑Undetermined Pending Circumstances Investigation Medical Certifier Name Title Dr Robert Beaty,MD '- Address ?.0 Glens Falls,NY 4 Death Certificate Filed District Number Register Number ff City, Town or Village Glens Falls,NY 5601 26 3 ❑Burial Date Cemetery or Crematory June 5, 2012 Pine View Crematorium ❑Entombment Address ©Cremation 21 Quaker Road,Queensbury,NY 12804 Date Place Removed z ❑Removal and/or Held _ and/or Address E Hold U) 0 Date Point of N ❑Transportation Shipment a by Common Destination Carrier El Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address :< Permit Issued to Registration Number '% Name of Funeral Home Regan& Denny Funeral Home 01444 �tf�. r yr Address rr 94 Saratoga Avenue, South Glens Falls,NY 12803 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address f;;# Permission is hereby granted to dispose of the human remains described above as indicated. A. Date Issued 'f;)Lf 1 1 'Z Registrar of Vital Statistics ti...)C�-si- W },£ (signature t District Number 5601 Place Glens Falls,NY I certify that the remains of the.decedent identified above were disposed of in accordance with this permit on: W Date of Disposition (oh,(it Place of Disposition K.U tW Cro-►dtaei,,. 2 (address) W CO CL (section) (lot )c- (grave number)Q Name of Sexton or Person in Charge of Premises 40A,(1114e- number Sl0Nrll+ Z (please print) W Signature 410, ...../t—r- Title 0/E MAZV(1-- (over) DOH-1555(02/2004)