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Jones, Tony 3O NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit G " Name First Middle Last Sex 0. Tony Rochester Jones Male Date of Death Age If Veteran of U.S. Armed Forces, 01/06/2018 54 Years War or Dates 1982-1984 Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause 0 Accident El Homicide Suicide ElUndetermined �Pending Circumstances Investigation Medical Certifier Name Title William Cleaver MD Address ,sF k 100 Park St,Glens Falls,New York 12801 p Death Certificate Filed District Number Register Number x City, Town or Village Glens Falls 5601 6 Date Cemetery Burial or Crematory :n 01/08/2018 Pine View Crematorium []Entombment Address ®Cremation Queensbury Haml a, New York Date Place Removed Removal and/or Held and/or Address _ Hold Date Point of Q Transportation Shipment ' ; by Common Destinatl Carrier Date CemeteryAddress 7 ❑Disinterment 41 ice; Date Cemetery Address Q Reinterment 144 Permit Issued to Registration Number -14 41 Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 I Address 3 ' 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom Fnk, Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. `,2 Date Issued 01/08/2018 Registrar of Vital Statistics g?pber&A Curtis(EfectronicaffySigned) - (signature) IV District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition //jo lig Place of Disposition .64.C.till t 1� (address) (section) A (lot number) (grave number) to / Name of Sexton or Person in Charge of P ises / it, `^A ease print)( Signature Title IRFtOttfO . rx (over) DOH-1555(02/2004)