Pratt, Gordon NEW YORK STATE DEPARTMENT OF HEALTH ,A, -yo1
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Gordon William Pratt Male
Date of Death Age If Veteran of U.S. Armed Forces,
December 10,2013 89 War or Dates World War H
Place of Death Hospital, Institution or
Z City, Town or Village North Elba Street Address 243 Old Military Rd.
p Manner of Death X Natural Cause Accident I I Homicide Suicide Undetermined Pending
w Circumstances Investigation
W Medical Certifier Name Title
O Woods McCahill,MD
Address
Placid Memorial Health Center,AMC-Lake Placid,Lake Placid,NY 12946
Death Certificate Filed District Number Register Number
City, Town or Village Town of North Elba 1560
❑Burial Date Cemetery or Crematory
Entombment December 13,2013 Pine View Crematory
Address
D Cremation 21 Quaker Rd.,Queensbury,NY 12804
Date Place Removed
ZO I I Removal and/or Held
and/or Address
E Hold
N
O Date Point of
N I I Transportation Shipment
O by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M.B. Clark,Inc. 01075
Address
2310 Saranac Ave.,Lake Placid,NY 12946
Name of Funeral Firm Making Disposition or to Whom
F- Remains are Shipped, If Other than Above
I Address
W
w
a.
Permission is hereby granted to dispose of the human re i descr' ab e as indicated.
Date Issued 12-11-2013 Registrar of Vital Statistics died
_rlf
District Number 1560 Place Town of North Elba
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition la-(3-13 Place of Disposition )24011..4 Crtecir or,_.
w (address)
U)
re
O (section) (lo number (grave number)
O Name of Sexton or Person 'n Charge of Premises r,l .<44C)
Z ( ease print)
w
LSignature Title cae wl ,•
(over)
DOH-1555 (02/2004)