Corey, Donald NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Donald Frederick Corey Male
Date of Death Age If Veteran of U.S. Armed Forces,
June 22 1995 69 War or Dates MY II
Place of Death Hospital, Institution or
City, Town or VillagGlens Falls Street Address Glens Falls Hospital
Manner of Death Fx�Natural Cause Accident F HomicideEj Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Robert V. Slionzo MD
Address
90 South St., Glens Falls MY 12801
Death Certificate Filed District Number Register Number
City, 'RoWt=VAtagsr Glens Falls 5601
Date Cemetery or Crematory
❑Burial June 26 1995 Pine View Crematorium
Address
®Cremation Tn of Queensbur , NY 12804
Date Place Removed
fl❑Removal and/or Held
�- and/or Hold Address
E�
Date Point of
[�Transportation Shipment
G by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
'> Name of Funeral HomCarleton Funeral Howe Inc. 00310
Address
P.O. Box 67, 68 Main St., Hudson Falls, K.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 above
as indi ted.
Date Issued "`�t0 % Registrar of Vital Statistics
(signature)
District Number 5601 Place city of Glens Falls , NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
f-
Date of Disposition $Place of Disposition G /jl 2 0 je-(Al C 2 al
(address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises
g (please print)
Signature Title Lr P— ni Q 7-C)L 5� i
DOH-1555 (10/89) p. 1 of 2 VS-61