Trumble Jr. Howard NEW YORK STATE DEPARTMENT OF HEALTH tr I q
viki
Vital Records Section r '' Burial - Transit Permit
Name First Middle Last Sex
Howard Curtis Trumble Jr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
03/12/2012 7.5 yeas War or Dates 1055-1958
1- P e of Death Hospital, Institution or
Z • Street Address
IIITowr� IICXX Glens Falls Park St Glens Falls, N Y 12810_1
anner of DeathrwiN Ntural Cause ❑Accident 0 Homicide 0 Suicide ❑Undetermined ❑trending
0In
Circumstances Investigation
at Medical Certifier Name Title
P. Christopher D. Hoy M. D.
Address
102 Park Street Glens Falls, N Y 12801
D ath Certificate Filed District Number Register Number
CA Tow ril1 XX Glens Falls 5601 120
Burial Date Cemetery or Crematory
DEntombment 03/14/2012 Pine View Crematory
Address
pC( mation Queensbury. NY
Date Place Removed
Z Removal and/or Held
2❑and/or
Address
Hold
0 Date Point of
trk❑Transportation Shipment
. by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment • Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D. Baker Funeral Home 01130
Address
•
11 Lafayette Street Queensbury, N Y 12804
Name of Funeral Firm Making Disposition or to Whom
' Remains are Shipped, If Other than Above
• Address
Cr
Ili
Permission is hereby granted to dispose of the human remains described above as indicated.
i Date Issued 03/14/2012 Registrar of Vital Statistics k"?
C a (signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
ILI Date of Disposition3— l a0r2 Place of Disposition aie Q(,,Lj 'r Qvncjc;r`,{V vn
(address)
ILI
CC (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises l 'v✓to4 et e1C�i/>,j
'fi �_--z,. �1 (please print)
l Signature L1✓v✓ 4 xt� Title (i-er-t4 t i s •
(over)
DOH-1555 (02/2004)