Loading...
Griffin, Thomas NEW YORK STATE DEPARTMENT OF HEALTI 2 t' D Vital Records Section Burial - Transit rermit Name First Middle Last Sex Thomas R. Griffin Male Date of Death Age If Veteran of U.S. Armed Forces, October 3, 2013 66 War or Dates Place of Death Hospital, Institution or City, Town or Village Argyle Street Address Pleasant Valley Manner of Death I771 Eli Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined El❑ Pending Circumstances Investigation Medical Certifier Name Title Barney Rubenstein, Dr. Address 33 Gilbert St. Cambridg , NY 12816 Death Certificate Filed District Number�w, �t U Registe Number City, Town or Village Argyle 1 5 7 Date Cemete or Crematory October 7, 2013 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed ❑ Removal and/or Held and/or Address ter, Hold Date Point of ❑Transportation Shipment by Common Destination Carrier ❑ Disinterment Date Cemetery Address Li Renterment Date Cemetery Address thr Permit Issued to Registration Number Name of Funeral Home M. B. Kilmer Funeral Home 01077 Address 123 Main St., Argyle NY 12809 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the huma ins described a•ove as indic ed. Date Issued \-k a,o( Registrar of Vital Statistics V,,_ L. \ (signature) 4-0 District Number 5`A�C.) Place UL.o‘(\ � -<-ciqe ft I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 10/07/2013 Place of Disposition Quaker Road Queensbury,NY 12804 s � (address) (section) A (lot numbert (grave number) 0 Name of Sexton or Perso in Charge f Premises Lit.-.- MHO ( ease print) Signature Title comitrert (over) DOH-1555 (02/2004)