Aubin, Alfred NEW YORK STATE DEPARTMENT OF HEALTH f _ J/I
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Alfred R Aubin Male
Date of Death Age If Veteran of U.S.Armed Forces,
1. July 7, 2013 a. War or Dates
Z Place of Death Hospital, Institution or
W City,Town,or Village Glens Falls Street Address Glens Falls Hospital
anner Death
0 M of `�`"'�latural Cause 0 Accident 0 Homicide Suicide �Undetermined El Pending
W �� Circumstances Investigation
Medical Certifier Name p Title
W A-iit kkv*E'Cf 144.0,
Q Addre sue_ -- r
1 9 A-14- ' FR-eek L,c) 41 t o Al( Ai D 14-- (d�o
Dealt)Certificate Filed District Number ( Register Number
City,Town or Village Glens Falls j GO/ cZ 85
0 Burial Date Cemetery or Crematory
July 9, 2013 Pineview Crematorium
❑Entombment Address
4 El Cremation 21 Quaker Road Queensbury, NY 12804
Date Place Removed
0 Ei Removal and/or Held
and/or Address
F Hold
0 Date Point of
0 0 Transportation Shipment
d by Common Destination
Carrier
Date Cemetery Address
a l Disinterment
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
2 Remains are Shipped, If Other than Above
ft
W Address
0.
Permission is hereby granted to dispose of the human remains described above s ind' e
Date Issued 6)74r/2043 Registrar of Vital Statistics A %cif i .i-
(signat re)
District Number ')6:70/ Place Glens Falls,New York
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
fDate of Disposition 07/09/2013 Place of Disposition Pineview Crematorium
2 (address)
Itl
0 (section) Iot number)S (grave number)
Name of Sexton or Person in C arge of Premise r,3`� r �'It�'
tu
Z (ple se print)
Signature Title CC,CiP1 d'lQ
(over)
DOH-1555 (02/2004)