Loading...
Proper, Richard NEW YORK STATE DEPARTMENT OF HEALTH '1 Vital Records Section • sir z- Burial - Transit Permit Name First Middle Last Sex Richard , Proper Male Date of Death Age If Veteran of U.S.Armed Forces, F Sept. 14, 2012 81 War or Dates Korean War Place of Death Hospital, Institution or Z City of Glens Falls Glens Falls Hospital City,Town,or Village Street Address 0 Manner of Death ®Natural Cause ❑ Accident ❑Homicide Suicide ❑Undetermined n Pending W Circumstances Investigation O Medical Certifier Name Title W Marvin Davidowitz MD 0 Address 100 Park Street, Glens Falls , New York 12887 Death Certificate Filed District Number— � Number v► Register Num er City,Town or Village ❑Burial Date Cemetery or Crematory Sept 18, 2012 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury, New York 12803 Date Place Removed 0 ❑Removal and/or Held - and/or Address ' Hold 0 Date `Point of 0 ❑Transportation Shipment d by Common Destination Carrier = Date Cemetery Address 5 ❑Disinterment ❑Renterment 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 it W Address 0. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 9 i 1 17 1_12.. Registrar of Vital Statistics (10C (signature) District Number 5 6 Q I Place ' 6 tZn"S Tv-`l S y Wy (2 ,30 t I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F- Z � rr V,, w Date of Disposition "t-i'y-t"1 Place of Disposition `I+Nt rt,,) r040 rf u,..-- 2 (address) W 0 0 (section) (I number) (grave number) d Name of Sexton or Per •n in Charge o Premises /jri r" e n,41+ 2 (please rint) W Signature / Title C2 E M ick d t (over) DOH-1555 (02/2004)