Loading...
Gage, Sr. Dennis NEW YORK STATE DEPARTMENT OF HEALTH , Vital Records Section Burial - Transit Permit s Name First Middle Last Sex Dennis Warren Gage Sr. Male Date of Death Age If Veteran of U.S. Armed Forces, July 24, 2018 76 War or Dates Place of Death I-IOspital, Institution or w City, Town or Village Fort Edward Street Address 46 McCrea Street Manner of Death Lu Natural Cause 0 Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending Circumstances Investigation Medical Certifier Name Title Paul R. Filion, Dr. Address 2 Irongate Center Glens Falls, NY 12801 Death Certificate Filed District Number n Register Numb City, Town or Village Fort Edward 5 15 4❑Burial Date Cemetery or Crematory July 25, 2018 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed -g. ❑ Removal and/or Held and/or Address E Hold 0` Date Point of ❑Transportation Shipment by Common Destination Carrier ❑ Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M. B. Kilmer Funeral Home- FE 01079 . " Address 82 Broadway, Fort Edward NY 12828 t Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address M. Permission is hereby granted to dispose of the human r diiii;ins desc ibed b e s indicated. (Q Re istrar of Vital Statistics ) it Y} Date Issued ��pLV)V 9 ./ r�� - I (signat re) District Number5�5 Place I A Q- I La a t . "' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 07/25/2018 Place of Disposition Quaker Road Queensbury,NY 12804 (address) S (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premises 1�►�,,,y Svaif‘S (please print) Signature,4 1 Title Cd{�' °r (over) DOH-1555 (02/2004)