Gallant, Raymond NEW YORK STATE DEPARTMENT OF HrH Z�'C
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
, Raymond Francis Gallant Male
113. Date of Death Age If Veteran of U.S. Armed Forces,
, * -,+018 96 Years War or Dates 1942-1948
Ir`r 'face of Dease- th Hospital, Institution or
ity, own or Village Saratoga Springs Street Address Wesley Health Care Center Inc
ner of Death Natural Cause ❑Accident El Homicide El Suicide El Undetermined ri Pending
'. Circumstances Investigation
. ! Medical Certifier Name Title
01 Diane Westbrook NP
Address
131 Lawrence St,Saratoga Springs,New York 12866
h Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 182
urial Date Cemetery or Crematory
03/28/2018 Pine View Crematorium
--.`Q Entombment Address
Cremation Queensbury Town. New York
Date Place Removed
• D Removal and/or Held
and/or Address
Hold
Date Point of
Transportation Shipment
by Common Destination
•- Carrier
• Disinterment Date Cemetery Address
Q Renterment Date Cemetery Address
_ Permit Issued to Registration Number
,,. Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Stpo Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
t'.
"'• Permission is hereby granted to dispose of the human remains described above as indicated.
W, Date Issued 032612018 Registrar of Vital Statistics Jain P Franc ,(Etectronicair Sijne4)
(signature)
y=. District Number 45Q1 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ex
Date of Disposition '3—,-53_. 1 7 Place of Disposition Pfns' v.t,� c t�:muAAaeV
(address)
iii
(1)'
i (section) (lot number) (grave number)
j Name of Sexton or Person in Charge of Premises J z,r M1,y 5 Z,v+ r,LS
(please print)
Ili Signature f eo " (2fig,i - Title C.drmct-joir
(over)
DOH-1555 (02/2004)