Loading...
Jones, Robert NEW YORK STATE DEPARTMENT OF HEALTH S #)1,0 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Robert John Jones Male Date of Death Age If Veteran of U.S. Armed Forces, September 14, 2018 64 .41Vtar or Dates F— Place of Death Hospital, Institution or WCity, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death Natural Cause El Accident Homicide Suicide El Undetermined El Pending Circumstances Investigation WW Medical Certifier Name Title Sean Bain, M.D. Dr. Address 100 park St. Glens Falls, NY 12801 Death Certificate Filed District Number Register Number City, Town or Village []Burial Date Cemetery or Crematory Pine Vew Crematorium ❑Entombment Address ©Cremation Queensbury,NY 12804 Date Place Removed Removal and/or Held and/or Address °�. Hold Date Point of Transportation Shipment by Common Destination C1 Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom [,_. Remains are Shipped, If Other than Above 2 Address W: Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued Registrar of Vital Statistics (signature) District Number Place I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: uj• Date of Disposition '100 8 Place of Disposition Queensbury,NY 12804 0.1 (address) (section) (lot number) (grave number) p Name of Sexton or Person in Charge of Premises 4 rua o++r Dvv ( lease print) W Signature Title al rm. (over) DOH-1555 (02/2004) I\