Aubrey, Michael NEW YORK STATE DEPARTMENT OF HEALTH1 It - rS
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Michael Sewell Aubrey Male
Date of Death Age If Veteran of U.S.Armed Forces,
Februa 7, 2014 67 War or Dates Vietnam
1 Place of Death Hospital, Institution or
W
City, Town or Village Glens Falls Street Address Glens Falls Hospital\
Manner of Death 0 Natural Cause 0 Accident Homicide Suicide 0 Undetermined Pending
UV Circumstances Investigation
Medical Certifier Name Title
Paul F Bachman MD,
Address
Warrensburg Health Center Warrensburg, NY 12885
Death Certificate Filed District Number Register Number
City, Town or Village 5601 bS
❑Burial Date Cemetery or Crematory
February 10, 2014 Pine Vew Crematorium
❑Entombment Address
®Cremation Queensbury,NY 12804
Date Place Removed
a El Removal and/or Held
and/or Address
E Hold BROWN CEMETERY
Date Point of
Transportation Shipment
Ofk by Common Destination
C Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Fit 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
Remains are Shipped, If Other than Above
2 Address
'444
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 2 PO//4/ Registrar of Vital Statistics W A
(signature)
District Number 5601 Place 6. v\_5 K C t 5 i" (,�
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
u= Date of Disposition 02/10/2014 Place of Disposition Queensbury,NY 12804
Z- (address)
iii
te
(section) d' (lot number) (grave number)
Gi. Name of Sexton or Person i Charge of Premises /. cht r J/tur(f
(please print)
W Signature Title CE649C,
(over)
DOH-1555 (02/2004)