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Winslow Sr, Carl NEW YORK STATE DEPARTMENT OF HEALTH t it 73 I Vital Records Section Burial - Transit Permit ilia Name First Middle Last Sex Oii Carl N. Winslow, Sr. Male Date of Death Age If Veteran of U.S. Armed Forces, 1 2/01/201 3 72 War or Dates yes— 1960 ' s Place of Death Hospital, Institution City, Town or Village Glens Falls Street Address Manner of Death GQrlens Falls Hospital © Natural Cause �Accident 0 Homicide 0 Suicide ❑ Undetermined ❑Pending Circumstances Investigation no Medical Certifier Name Title Max Crossman MD. Address Whitehall, NY. 12887• V >>3 Death Certificate Filed District Number Regise Number City, Town or Village Glens Falls 5601 5�t r Date Cemetery or Crematory El Burial 12/04/2013 PineView Crematorium Address Cremation Queensbury, NY. 12804 gDate Place Removed 0❑Removal and/or Held -- and/or Address Hold O Date Point of No Transportation Shipment a by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address ` <3 Permit Issued to Registration Number Name of Funeral Home Mason Funeral Home 01117 A• ddress 18 George St. , Fort Ann, NY. 12827 iii Name of Funeral Firm Making Disposition or to Whom ap.b'" Remains are Shipped, If Other than Above WC A• ddress • Cr tt M Permission is hereby granted to dispose of the human remains described above in c d. Date Issued 1 2/0 4/1 3 Registrar of Vital Statistics >,-;,.7 si nature ( 9 ) District Number 5601 Place city of Glens Falls, NY. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W D• ate of Disposition 14-3-13 Place of Disposition 4 JLL C..ctot'Nr— W (address) N C (section) o n tuber) (grave number) Name of Sexton or Person incharge of Premises4( �.;;� + �.Y,,� g (please print) W Signature Title CiTiM 4 (over) DOH-1555 (9/98)