Corlew, Paul NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last S
PA U L W. Cor f e w e
Date of Death Age If Veteran of U.S. Armed Forces,
Jan. 31 , 19 9 79 War or Dates yes WWII
Place of Death City of GLens Falls Hospital, Institution or GLens FAlls Hospital
City, Town or Village Street Address
Manner of Death ®Natural CauseEj Accident []Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Eric Leefmans MD
Address
102 Park St. GLens FAlls, New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village City of GLens Falls 5601
Date Cemetery or Crematory
❑Burial Feb. 2, 1998 Pine VIew Crematory
Address
x❑Cremation Tn. of Queensbury, New York
FDate Place Removed
Z❑Removal and/or Held
.•• and/or Address
Hold
Q Date Point of
❑Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to M. B. Kilmer Funeral Home Registbl ' Number
Name of Funeral Home
Address
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 descr'bed above as di
c
Date Issued 2-2-98 Registrar of Vital Statistics
(signature)
District Number 5601 Place Ci f of GLens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
z Date of Disposition '3`� Place of Disposition �/ ALAIE:i ,�4J �/Z.�/y1/9 t�/r�Al
+, (address)
i�
N
t� (section) Q (lot number) � ) (grave number)
GName of Sexto or Person in Charge of Premises /YjAT/��4J
g (please print) i
Signature Title
DOH-1555 (10/89) p. 1 of 2 VS-61