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Guy, Byron 41 1s NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Byron K Guy Male Date of Death Age If Veteran of U.S.Armed Forces, December 09,2013 76 War or Dates 1955-57 I- Place of Death Hospital, Institution or Z City, Town or Village Village of Corinth Street Address 400 Oak St.Apt 2 Ca Manner of Death©Natural Cause 0 Accident ❑Homicide ❑Suicide 1ri—1 Circumstances El Pending Circumstances Investigation tu Medical Certifier Name Title John E Lulaszewicz, MD Address 84 Broad Street,Glens Falls, NY Death Certificate Filed 12-09-2013 District Number Register Number City, Town or Village 4521 10 OBurial Date Cemetery or Crematory December 10, 2013 Pineview Crematory ❑Entombment Address ®Cremation Queensbury, NY , Date Place Removed Removal and/or Held and/or Address CO Hold 0 Date Point of ID Transportation Shipment by by Common Destination Carrier fA Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home, Inc. 00448 Address 7 Sherman Avenue,Corinth, NY 12822 gA Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Densmore Funeral Home, Inc. Address 7 Sherman Avenue,Corinth, NY €t Permission is hereby granted to dispose of the human re ns de cribed e 1 'cated. Date Issued December 09,2013 Registrar of Vital Statistics ✓ (signature) St- �District Number 4521 Place Co , 77y , I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: g, Date of Disposition idfl31l3 Place of Disposition ��� �„�-�ot '— ;, (address) (section) /((lot number) (grave number) Name of Sexton or Person in Charge f Premises Itr ,Q"Htr z ( e print) Signature41,— Title (ECM trAlif- (over) DOH-1555 (02/2004)