Griffin, Daniel NEW YORK STATE DEPARTMENT OF HEALTH �3y
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Daniel Stevens Griffin Male
Date of Death Age If Veteran of U.S. Armed Forces,
06/29/2018 88 Years War or Dates 1953-1975
Place of Death Hospital, Institution or
City, Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
Manner of Death Natural Cause Ei Accident El Homicide El Suicide nUndetermined El Pending
Circumstances Investigation
Medical Certifier Name Title
Pamela Casey NP
Address
319 Broadway,Fort Edward Town,New York 12828
Death Certificate Filed District Number Register Number
City, Town or Village Fort Edward 5755 31
OBurial Date Cemetery or Crematory
07/02/2018 Pine View Crematorium
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
`_ El Removal and/or Held
.; and/or
Address
Hold
Date Point of
Q Transportation Shipment
by Common Destination
Carrier
1 Disinterment Date Cemetery Address
Q Reinterment
• Date Cemetery Address
Permit Issued to Registration Number
I Name of Funeral Home Carleton Funeral Home Inc 00281
l Address
I`I 68 Main Stpo Box 67,Hudson Falls,New York 12839
:e Name of Funeral Firm Making Disposition or to Whom
- Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
t� Date Issued 07/02/2018 Registrar of Vital Statistics Aimee Mahoney(ECectronical2ySigned)
(signature)
.
District Number 5755 Place Fort Edward, New York
_! I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 11 S. li$ Place of Disposition gJ.i (�
(address)
(section) (lot n ber) (grave number)
: Name of Sexton or Person in Charge of Premises PIRA- Stu'
(please p nt)
F"
Signature It Title
(over)
DOH-1555 (02/2004)