Meyer, George NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
George Joseph Meyer Male
;:i Date of Death Age If Veteran of U.S. Armed Forces,
December 1 8, 2013 85 War or Dates
}- Place of Death Glens Falls Hospital, Institution or Glens Falls Hospital
W. City, Town or Village Street Address
Manner of Death J Natural Cause 0 Accident D Homicide 0 Suicide Undetermined �Pending
titCircumstances Investigation
W Medical Certifier Name Title
Ct Robert Sponzo MD
Address 102 Park Street Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
ft City, Town or Village
OBurial Date 1 2/2 0/2 013 Cemetery or Crematory
Pine View Crematory
Entombment Address
DCremation 21 Quqker Road, Queensbury, NY 12804
Date Place Removed
❑and/or Address
Removal and/or Held
i;;,
Hold
i!?
V Date Point of
it0 Transportation Shipment
Chi by Common Destination
Carrier
Q Disinterment Date Cemetery Address .
igQ Reinterment Date Cemetery Address
i! Permit Issued to Registration Number
Name of Funeral Home M:B Kilmer Funeral Home 001
i> Address
82 Broadway Fort Edward, NY 12828 •
Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped, If Other than Above
• Address
t
Ui
'IL
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued Registrar of Vital Statistics ��A ' ,� ,
v gnature)
District Number 5 6 ® J Place 6 Sv4,3, v` 5 l k/
-- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z.
ILI go/U�,, �,�k�
Date of Disposition 12-4c1-i3 Place of Disposition
(address)
ill
Ilr (section) lot number) c (grave number)
Name of Sexton or Person . harge of remises ffa/�/J(Mier ^�bt"
Z. (pie se print)
W Signature Title el4PWCaL
(over)
•
DOH-1555 (02/2004)