Kilmartin, Jr. Raymond NEW YORK STATE DEPARTMENT OF HEALTH i.
% it Si;
Vital Records Section Burial - Transit Permit
,ix
Name First Middle Last I Sex
Raymond Harris Kilmartin Jr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
July 4, 2018 55 War or Dates
I'- Place of Death Hospital, Institution or
W' City, Town or Village Albany Street Address Albany Medical Center
W Manner of Death X❑Natural Cause 0 Accident ❑ Homicide ❑ Suicide ❑ Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
Dr 37e -c•C _, ,b :ra 1 ' pk7 t 0 Arsv►er
Address
ii 51-a'k2- S .. )413av177 NI l 7... cl 7
Death Certificate Filed District Klumber Register Number
City, Town or Village f�fpg
❑Burial Date Cemetery or Crematory
July 9, 2018 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
,.- Date Place Removed
71❑ Removal and/or Held
and/or
Address
_. Hold
U? Date Point of
ct.. ❑Transportation Shipment
01 by Common Destination
C Carrier
❑ Disinterment Date Cemetery Address
,_ ❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
rw Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
l ' Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
17 Remains are Shipped, If Other than Above
• Address
W,.
▪ Permission is her by granted to dispose of the human rem i s described ove as indicated.
Date Issued O/ O(v Zoj8Zegistrar of Vital Statistics
(signature)
, District Number 0)01 Place � 0 F A I h ,(1 _-(
1
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W,
• Date of Disposition 07/09/2018 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
0
W (section) ,lot number) C (grave number)
O Name of Sexton or Person in Charge of Premises bfal )v-4401
Z 1 (plse print)
W Signature dj._
Title Au-4E
(over)
DOH-1555 (02/2004)