Griffin, Richard r II
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Richard Nelson Griffin Male
Date of Death Age If Veteran of U.S.Armed Forces,
09/19/2018 55 Years War or Dates
.- Place of Death Hospital, Institution or
Wa City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death J Natural Cause Eil Accident 0 Homicide D Suicide 0 Undetermined 0 Pending
Circumstances Investigation
1 Medical Certifier Name Title
William Borgos MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 447
r DBurial Date Cemetery or Crematory
09/21/2018 Pine View Crematory
Entombment Address
r ®Cremation Queensbury Town, New York
Date Place Removed
Removal and/or Held
and/or Address ,
N - Hold
44-0Date s Point of
Transportation Shipment
by Common Destination
• Carrier
Q Disinterment Date Cemetery Address
• Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
• Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
5
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/20/2018 Registrar of Vital Statistics Robert_A Curtis('E1 ctronzicattySigned)
(signature)
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:
W Date of Disposition q Izi It Place of Disposition jJ... ifMJlvr+...
,E (address)
l!
(section) (lot number) (grave number)
�h nsi j
Name of Sexton or Person in Charge of Pfemises p� qt.(pldase print)
Signature Title tiZtft Y W
(over)
DOH-1555 (02/2004)