Howes, Sr. Jeffrey $ 3-S3
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Jeffrey Lee _ Howes Sr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
July 2, 2018 46 War or Dates
Place of Death Hospital, Institution or
Lu City, Town or Village South Glens Falls Street Address 138 Saratoga Ave.
0 Manner of Death 0 Natural Cause Accident Homicide Suicide Undetermined ❑ Pending
0Circumstances Investigation
Medical Certifier Name Title
Michael Sikirica MD,
Address
50 Broad Street Waterford, NY 12188
Death Certificate Filed District Number Register Number
City, Town or Village
Burial Date Cemetery or Crematory
July 9, 2018 Pine View Crematorium
: ❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ri Removal and/or Held
and/or Address
Hold
CO Date Point of
a. 0 Transportation Shipment
C1 by Common Destination
0 Carrier
ss: 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
I- Remains are Shipped, If Other than Above
2 Address
a:
W'
Permission is hereby granted to dispose of the human remain scribed above as indicated.
i
Date Issued 7 f G'_ /20/3" Registrar of Vital Statistics C�
(signature)
District Number �-�,�y Place Ul >1�QyL ��i , (%,1,��Y�- �7/�G^i'
%l
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)
W
CO
W (section) Allot number) (grave number)
Name of Sexton or Person in C rge of Pre ises rc► `S�'""`
(pie9se print)
111 i ature � Title
( Pit.
Signature
(over)
DOH-1555 (02/2004)