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Watson, Joseph SldLNEW YORK STATE DEPARTMENT OF HEALTH 4 7 Vital Records Section Burial - Transit Permit 4 Name First Middles Last Sex Joseph Watson Male Date of Death Age If Veteran of U.S. Armed Forces, April 28, 2013 59 War or Dates I Place of Death Hospital, Institution or W City, Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death❑ Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending Circumstances Investigation W Medical Certifier Name Title CI Address Death Certificate Filed District Number Register Number City, Town or Village ❑Burial Date Cemetery or Crematory Pine View Crematorium ❑Entombment Address ®Cremation Quaker Road Queensbury,NY 12804 Date Place Removed O Eland/or Removal and/or Held Address F.: Hold CO Date Point of 0 ❑Transportation Shipment 0) by Common Destination d Carrier Date Cemetery Address ❑ Disinterment Date Cemetery Address ❑ Reinterment 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 11-- Remains are Shipped, If Other than Above 2 Address re W " ,/,) ' Permission is heZ7r ?dIros?: t :anate Issued tal s C® .. / signature) District Number�r„0/ Place 41.-7/— d 7 I certify that the remains of the decedent identified above were disposed of in accordant with this permit on: Z J' /' W Date of Disposition 5— b-V3 Place of Disposition e ind 1rei0'— 2' (address) UI ir (section) (lot number) (grave number) © Name of Sexton or P rson in Charg of Premises 4. L Sft Z' (phase print) W Signature Title vita., (over) DOH-1555 (02/2004)