O'Neil, Terrance Wayne • r Il os-
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Terrance Wayne O'Neil Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/06/2020 82 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
ILI
aManner of Death xi Natural Cause El Accident0 Homicide Suicide Undetermined 0 Pending
UCircumstances Investigation
W Medical Certifier Name Title
CI Jeremy Di Bari MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 502
ElBurial Date Cemetery,Crematory or Facility Name
11/13/2020 Pine View Crematorium
❑Entombment Address
EiCremation Queensbury Town,New York
Donation
O Removal and/or Date Place Removed
and/or Held
I-
- Hold Address
(
0
d Date Point of
ID ❑Transportation
CI by Common Shipment
Carrier Destination
❑Disinterment
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
H Remains are Shipped,If Other than Above
Address
CC
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/09/2020 Registrar of Vital Statistics 1Wert Andrew Curtis(E(ectronicalySigned)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
A
Z Date of Disposition 11113)70 Place of Disposition n•e�i— DES
W
2 (address)
W
cn
CC (section) (lot nuAber) r (grave number)
0 Name of Sexton or Person in Charge of Premises 1 h 6r't M
z (please print) U /`
W Signature �` Title !h�M�
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) . 141 cl .
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Receipt
Human remains of delivered on ,
Pine View Cemetery Representing the funeral home named on burial pe
Official Funeral Directors Reg.or License#