Aust, Douglas i
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Aust Male
Date of Deat Age If Veteran of U.S. Armed Forces,
67
War or Dates Yes Korea
P ace of Death Hospital, Institution or
City, Town or Village Street Address Glens Falls Hospital
Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
re M.Castro MD
Address
102 Park St-Glens FAlls,NY
Death Certificate Filed District Number Regist r Number
City, Town or Village Glens Falls 5601
Date Cemetery or Crematory
❑Burial 5/11 /99 Pine View Crematorium
Rkremation Address Queensbury,NY
Date Place Removed
Z❑Removal and/or Held
•• and/or Address
Hold
0 Date Point of
Q Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Sullivan - Minahan & Potter 01837
Address
407 Bay Rd,Queensbury NY 12804
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 r mains described a ve as indica d.
Date Issued 5/11/99 Registrar of Vital Statistics
(sign ure)
District Number 5601 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 Disposition .3 -SO-' Place of Disposition /,!
W. (address)
W
N
i>E (section) (lot number /(grave number)
0 Name of Sexton r Per so in Charge of Premises
g (please print n r
Signature Title �/ r
(over)
DOH-1555 (9/98)