Generous, Gary VI
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transitermit
Vital Records Section
Name First Middle` Last Sex
Gary W. Generous Male
Date of Death Age If Veteran of U.S.Armed Forces,
I. August 3, 2013 54 War or Dates 1977-1980
2 Place of Death Hospital, Institution or
W City,Town,or Village Queensbury Street Address Residence
G Manner of Death X❑Natural Cause ❑ Accident ❑Homicide ❑Suicide ❑Undetermined ❑ Pending
Circumstances Investigation
U Medical Certifier Name Title
W Dr. Michael Lynch, M.D. Dr.
d Address
160 Allen Street, Rutland, VT 05701
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 0-7,5—A (5' —/3
❑Burial Date August 6, 2013 Cemetery or Crematory
Pineview Crematorium
❑Entombment Address
❑% Cremation Queensbury, New York Queensbury, NY 12804
Date Place Removed
0 ❑Removal and/or Held
and/or Address
(' Hold
0 Date Point of
0 ❑Transportation Shipment
O. by Common Destination
0Carrier
Date Cemetery Address
8 ❑Disinterment
E Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home, Inc. 00885
Address
46 Williams Street, Whitehall, New York 12887
— Name of Funeral Firm Making Disposition or to Whom
ii Remains are Shipped, If Other than Above
W Address
O.
Permission is hereby granted to dispose of the human remains de bed(a s indicated.
Date Issued $" If (3 Registrar of Vital Statistics //
ure) "—'—'i
District Number rj7 SA Place Queensbury,New York
N
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
w Date of Disposition 118113 Place of Disposition Pineview Crematorium
2 (address)
W
0 0 (section) (lot per) ç ( ave number)
Name of Sexton or Person in C arge of Premis ; 1rl�i f
Z (p ease pri t)
W
' Signature Title cram/Trot
(over)
DOH-1555 (02/2004)