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Aiken, Sr. Joseph NEW YORK STATE DEPARTMENT OF HEALTH 55 Li Vital Records Section Burial - Transit Permit ems: Name First Middle Last Sex Joseph Edward Aiken Sr. Male 41 41 Date of Death Age If Veteran of U.S. Armed Forces, October 15, 2012 72 War or Dates Place of Death Hospital, Institution or City, Town or Village Street Address Glens Falls Hospital Manner of Death 0 Natural Cause ❑ Accident ❑ Homicide n Suicide ElUndetermined ❑ Pending Circumstances Investigation Medical Certifier Name Title Graham Atkins, Dr. �r Address f 161 Carey Road Queensbury, NY 12804 Death Certificate Filed District Number • Register Number City, Town or Village 5 6CJ ) t-i t'2 ❑Burial Date Cemetery or Crematory sm October 19, 2012 Pine View Crematory a: ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed Removal and/or Held and/or Address E. Hold Date Point of nTransportation Shipment by Common Destination 1i Carrier ; Date Cemetery Address ❑ Disinterment sZs .Is Date Cemetery Address ❑ Reinterment Permit Issued to Registration Number sl Name of Funeral Home M. B. Kilmer Funeral Home 01079 t Address 82 Broadway, Fort Edward NY 12828 os Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above IX Address Permission is hereby granted to dispose of the human remains described above as ipdicated. �x Date Issued 14 J i - f i -z Registrar of Vital Statistics W (signature) District Number 5 6 0 1 Place 6 SRil k\5 t Ntf? IQ 1 a ) I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: iK ZA Date of Disposition 10/19/2012 Place of Disposition Quaker Road Queensbury,NY 12804 M. (address) a 44 (section) A (lot number) (grave number) Name of Sexton or Person in Charg of Premises G ^(s)fit, r� �.,��} (p/ ase print) Signature Title � i4 � \t. (over) 1555 (02/2004)