Loading...
Cole, Ronald NEW YORK STATE DEPARTMENT OF HEALTH ' 7c Vital Records Section INa Burial - Transit Permit Name First Middle . Last Sex : ,,,� Ronald G. Cole Male F.<,. Date of Death Age If Veteran of U.S. Armed Forces, fF January 8, 2013 88 War or Dates {'r�i Place of Death Hospital, Institution or City, Town or Village Ft. Edward Street Address Fort Hudson Nursing Home Manner of Death Natural Cause n Accident Homicide C Suicide n Undetermined 1 Pending Circumstances Investigation i91 Medical Certifier Name Title Bernardo Vilajuan,MD Address 161 Carey Rd.Queensbury,NY 12804 Death Certificate Filed District Nu ber. Register Number City, Town or Village Ft.Edward J 7S r ❑Burial Date Cemetery or Crematory January 10,2013 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road, Queensbury, NY 12801 Date Place Removed ZZ ri Removal and/or Held and/or Address E Hold V) 0 Date Point of u) L Transportation Shipment p by Common Destination Carrier E Disinterment Date Cemetery Address El Reinterment Date Cemetery Address ,r> Permit Issued to Registration Number Name of Funeral Home Regan& Denny Stafford Funeral Home 01443 ', Address 53 Quaker Road, Queensbury,NY 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is he b granted to dispose of the hu an rema' escri ve aS indicated. Date Issued /9 2D43 Registrar of Vital S " " s ..---- - (signature) District Number 67,13 Place Ft.Edward I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z J Vg,a WW Date of Disposition ! -11-/3 Place of Disposition Pnott_ �,� 4 W (address) ca CZ (section) — ( (lot number) j (grave number) p Name of Sexton Perso in C of Premises �_�C �//`ll-jci/ W Signature Title la�I�46 lease prin (over) DOH-1555(02/2004)