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Townsend , Edward NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Vital Records Section Name First Middle Last Sex Edward Francis Townsend Male Date of Death Age If Veteran of U.S. Armed Forces, War or Dates Place of Death Hospital, Institution or City, TOMM0066ftwx G31 ens Balls Street Address Manner of Death Undetermined Pending Natural Causes[-]Accident ❑ Homicide ❑ Suicide ❑ Circumstances ❑ Investigation Medical Certifier Name Title Carl R. Szot Jr. MD Address :::'.....Death Certificate Filed District Number Register Number City, T� Glens Falls 56014 3 ❑ Burial ate Cemetery or Crematory July 9, 1999 Pine View CrematoriLun © Cremation Address Tn of Queensbury, NY 12804 Date Place Removed ❑ Removal and/or held and/or hold Address Date Point of ❑ Transportation by Shipment Common Carrier Destination Date Cemetery Address ElDisinterment Date Cemetery Address ❑ Reinterment ....:.:.:.Permit issued to Registration Number :::::::Name of Funeral Firm Carleton Funeral Hone Inc. 00297 Address P.O. Box 67, 68 Main St. , Hudson Falls, N.Y. 12839 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 ove as indicat d. Date Issues)�� Registrar of Vital Statistics — (Signature) District Number 56014 Place. Glens Falls, NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Dispositio �01 Place of Disposition .6� G (a dress) (Section) (Lot Number) (Grave Number) Name of Sexton or Person in Charge of P mises �/ �--•(Please Print) Signatur Title d �� DOH-1555 (10/89) p. 1 of 2 VS-61