Palmer Jr., Paul Wesley NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Paul Wesley Palmer Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/21/2021 60 Years War or Dates
F Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death Natural Cause ❑Accident El Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
WW Medical Certifier Name Title
Gamal Khalifa MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 59
ElBurial Date Cemetery,Crematory or Facility Name
01/28/2021 Pine View Crematorium
El Entombment Address
11 Cremation Queensbury Town,New York
❑Donation
Z Date Place Removed
0 ❑Removal
and/or and/or Held
Hold Address
0
Cl)'LiTransportation Date Point of
CI by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
ElReinterment 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
F. Remains are Shipped,If Other than Above
2 Address
CC
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/27/2021 Registrar of Vital Statistics 99bert Andrew Curtis(EtectronicaCCySigned)
(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:
Z Date of Disposition //Zg r'74 Place of Disposition
IL
(address)
W
CC (section) (19)umber) (grave number)
gName of Sexton or Person in Charge of P ises rss �M„alt
Zr (please pr t)
W (lrlSignature Title �'� �
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 014 4 7
Receipt
Human remains of delivered on 20
Pine View Cemetery - Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#