Loading...
Wagar, Eugene NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex EUDate of eath Agee R� If Veteran of US Armed Forces, male Nov. 27, 2013 87 War or Dates 1944-46 Place of Death Hospital, Institution or w City, Tilwadzklakcifbc Glens Falls Street Address Glens Falls Hospital W Manner of Deathliz Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined El❑ Pending Circumstances Investigation W Medical Certifier Name Title 0; Thomas E. Hafer, MD Address Glens Falls, NY Death Certificate Filed District Number Register Number cdt ll City, Tc e Glens Falls 5601 ❑Burial Date Cemetery or Crematory Nov. 29, 2013 Pine View Crematorium ❑Entombment Address , ❑ emation to of Queensbury, NY Date Place Removed z Removal and/or Held I I 0 and/or Address E Hold 0 Date Point of Lit. ❑ Transportation Shipment by Common Destination 0' Carrier ❑ Disinterment Date Cemetery Address Date Cemetery Address ❑ Reinterment Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address 68 Main St., Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom I— Remains are Shipped, If Other than Above P2 Address W, 44:' Permission is hereby granted to dispose of the human remains de ri a 7yeriztjted. Date issued /t/2?/2©z3 Registrar of Vital Statistics (signature) District Number 5601 Place City of CJ ens Fall s, NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: uj• Date of Disposition IZ'l-13 Place of Disposition 4?at,.) ,�i0[:— 2 (address) to (section) 7jliumber) c, (grave number) O Name of Sexton or Person i Charge of Pr mises ' �(""� r (please rint) lJJ Signature Title CI&or t P (over) DOH-1555 (02/2004)