Battease, Richard NEW YORK STATE DEPARTMENT OF HEALTI-I% t # i'c
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
444,
Richard Battease Male
Date of Death Age If Veteran of U.S. Armed Forces,
February 18, 2014 82 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death1=1 Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined El❑ Pending
Circumstances Investigation
Medical Certifier Name Title
Farhana Kamal, M.D. Dr.
Address
100 Park Street Glens Falls, NY 12801
-,o4 Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls L.SWa/ A
Date Cemete or Crematory
El Burial February 20, 2014 Pine View Creatory
❑Entombment Address
-. ®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
° and/or Address
Hold
Date Point of
3 ❑Transportation Shipment
g.1 by Common Destination
Carrier
lissDisinterment
-
Date Cemetery Address
❑ Renterment
Date Cemetery Address
=g , Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home 01077
Address
123 Main St., Argyle NY 12809
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
,,,.. Permission is her by granted to dispose of the human emains escribed ovve as in. . - >.44
Date Issued ('� j/ Registrar of Vital Statistics e'_(/,—f--yb 1 00"--�
(signature)
District Number �.r`66/ Place rfeeif_ c e_,—g(/ W
I certify that the remains of the decedent identified above were disposed of in accordan with this permit on:
�f Date of Disposition 02/20/2014 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) (lot numbery- (grave number)
ti O
Name of Sexton or Person iry harge of remises .s-
7/ lease print)
4
Signature Title arnipe
(over)
DOH-1555 (02/2004)