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Griffin, Hiram SY0 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Hiram V Griffin Male Date of Death Age If Veteran of U.S.Armed Forces, 06/30/2018 89 Years War or Dates 1946-1948 °" Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause 0 Accident 0 Homicide Suicide Undetermined Pending Circumstances Investigation al Medical Certifier Name Title CI Nawed Siddiqui MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 322 ❑Burial Date Cemetery or Crematory 07/05/2018 Pineview Crematorium ❑Entombment Address ®Cremation Queensbury, New York Date Place Removed El Removal and/or Held and/or Address Hold Date Point of QTransportation Shipment • by Common Destination ▪ - Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Jillson Funeral Home Inc 00885 Address 46 Williams Street,Whitehall Village,New York 12887 c. Name of Funeral Firm Making-Disposition or to Whom 14 Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. 0 Date Issued 07/03/2018 Registrar of Vital Statistics Rp6ert A Curtis(ECectronicafTy Signed) (signature) District Number 5601 Place Glens Falls, New York 1.4 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition l/to fig Place of Disposition &AL., r',y,.eu,. (address) (section) lot number) r (grave number) Name of Sexton or Person in Charge of Premises L nr4 J kwei (p/eefse print) Signature Title iltln- (over) DOH-1555 (02/2004)