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Granger, Charles NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Charles Delbert Granger male Date of Death Age If Veteran of U.S. Armed Forces, June 28 1998 56 War or Dates unknown Place of Death Hospital, Institution or City, TvwR z)mVjRag a Glens Falls Street Address Glens Falls Hospital Manner of Death ®Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation Medical Certifier Name Title Robert Sponzo, MD Address Cancer Center at Glens falls Hospital , Glens falls , NY Death Certificate Filed District Number Register Number City,4-d% bpc% Glens Falls 5601 3 Date Cemetery or Crematory ❑Burial June 30 1998 Pine View Crematorium Address ©Cremation Town of Queensbury, NY Date Place Removed z❑Removal and/or Held ••• and/or Address Hold Q Date Point of NQ Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home , Inc 00313 Address P . O . Box 672 68 Main St . , Hudson falls , NY 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby ranted to dispose of the human mains described abov indicated. Date Issued Registrar of Vital Statistics ( gnature) District Number 5601 Place City of lens F a 11 s , NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WW. Date of Disposition Place of Disposition lei �� � W Cry a-To R 10 M (address) lJj (section) (lo n tuber) (grave number) 0 Name of Sexton or Person in Charge of Premises C z (please pr nt Signature Title C h 2 Xn a�TC�r_Y DOH-1555 (10/89) p. 1 of 2 VS-61