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Greene, David Russell - • - if- la NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex David Russell Greene Male Date of Death Age If Veteran of U.S.Armed Forces, 02/06/2021 69 Years War or Dates F- Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital ILI UpManner of Death © Natural Cause ❑Accident Ei Homicide ❑Suicide ❑Undetermined DPending Circumstances Investigation W Medical Certifier Name Title G Asim Chaudry MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 88 ElBurial Date Cemetery,Crematory or Facility Name 02/09/2021 Pine View Crematorium ❑Entombment Address lCremation Queensbury Town,New York ❑Donation g CI Removal Date Place Removed and/or and/or Held t— N Hold Address 0 G. Date Point of N ❑Transportation p by Common 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 l— Remains are Shipped,If Other than Above % Address CC W tL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/08/2021 Registrar of Vital Statistics lZpbertAndrew Curtis(E1ectronica1Ty Signed) /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: ~ ��L o� Z Date of Disposition 01! ?{ Place of Disposition 2 (address) W NCC (section/ !ot number) (grave number) 0 Name of Sexton or Person in Charge of Premises r`� 1 �r 41t z (plea print) W Titleiftord kfiv 1'c Signature DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) _ 9 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#