Reid, Eugene O'Neill 11- 11g3
NEW YORK STATE DEPARTMENT OF HEALTH / Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Eugene O'Neill Reid Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/03/2020 63 Years War or Dates 1977-1977
Place of Death Hospital,Institution or
z City,Town or Village Hudson Falls Village Street Address 264 Main Street Apt.C3,Hudson Falls Village,New York 12839
ci W Manner of Death ❑Undetermined Pending
Cause Accident 1=1Homicide. Suicide
Circumstances Investigation
WMedical Certifier Name Title
0 Robert Lemieux Coroner
Address
415 Lower Main Street,Hudson Falls Village,New York 12839
Death Certificate Filed District Number Register Number
City,Town or Village Hudson Falls Village 5726 36
Burial Date Cemetery,Crematory or Facility Name
11/05/2020 Pine View Crematorium
Entombment Address
ElCremation Queensbury Town,New York
Donation
0 El Removal Date Place Removed
and/or and/or Held
- Hold Address
0
d Date Point of
t/) ❑Transportation
p by ComrOon Shipment
Carrier Destination
El 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
2 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/05/2020 Registrar of Vital Statistics CynthiaA(darn(ECectronicairy Signed)
(signature)
District Number 5726 Place Hudson Falls Village, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permi •
W Date of Disposition II— `ZO Place of Disposition V,_
(address)
W
CC CC (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge o P emises t Cy �, ✓,vA li
Z (pIelyse print)
W Signature Title c'lMt{�YZ
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) j 14 17 c
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors ' -• r Lice se#