Griffin, Duane NEW YORK STATE DEPARTMENT OF HEALTH �2
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Duane T. Griffin Male
Date of Death Age If Veteran of U.S. Armed Forces,
March 9,2013 71 War or Dates
._ Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
0 Joseph C.Mihindu MD
Address
20 Murray Street,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls,NY 5601 1 0 2.
❑Burial Date Cemetery or Crematory
Entombment March 12,2013 Pine View Crematory
Address
EI Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
H Hold
U
0 Date Point of
yTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00035
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped, If Other than Above
2 Address
W
O.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 3/1 z/i3 Registrar of Vital Statistics
(signa ure)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
us Date of Disposition 3--/(/-/3 Place of Dispositionalfe- ,E-Kl
(address)
N
(section) j mber) (grave number)
p Name of Sexton Person in arge of Premises o�U 4//
(lot n
please print)
W
Signature // Title (; st- rL -
(over)
DOH-1555(02/2004)