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Hassett, Don Gordon 171,6 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Don Gordon Hassett Male Date of Death Age If Veteran of U.S.Armed Forces, 11/15/2020 90 Years War or Dates 1952-1954 Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc tL▪ Manner of Death © Undetermined Pending Natural Cause 1=1Accident Homicide Suicide lL Circumstances Investigation W Medical Certifier Name Title O Carrie Miron PA Address 319 Broadway,Fort Edward Town,New York 12828 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 96 ❑Burial Date Cemetery,Crematory or Facility Name 11/17/2020 Pine View Crematorium 0 Entombment Address 1 Cremation Queensbury Town,New York ❑Donation ZZ ❑Removal Date Place Removed and/or and/or Held N Hold Address 0 O. Date Point of co 1-1 Transportation p by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67, Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom 1 . Remains are Shipped,If Other than Above 2 Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/16/2020 Registrar of Vital Statistics Aimee Makoney(ECectronically Signed) (signature) District Number 5755 Place Fort Edward, 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 II IIg 120 Place of Disposition 2 (address) W (section) ( number) (grave number) • Name of Sexton or Person in Charge of Prea Li Z (please pf nt) Signature Title (YW""tTjvit DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014206 Receipt Human remains of delivered on , 20_ Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# I