Loading...
Case, John David r If . ..!. z sJ NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John David Case Male Date of Death Age If Veteran of U.S.Armed Forces, 03/03/2021 82 Years War or Dates 1953-1983 N Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital W• Manner of Death ©Natural Cause ❑Accident El HomicideEl Suicide ❑Undetermined 0 Pending Circumstances Investigation W Medical Certifier Name Title C Mathew Varughese DO Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 131 - ❑Burial Date Cemetery,Crematory or Facility Name 03/08/2021 Pine View Crematorium ❑Entombment Address X❑Cremation Queensbury Town,New York ]❑Donation Z Removal Date Place Removed O Eland/or and/or Held N Hold Address 0 Cl) ❑Transportation Date Point of p by Common Shipment Carrier Destination ❑Disinterment Date ' Cemetery Address IDReinterment 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 C W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/05/2021 Registrar of Vital Statistics cR96ertAndrew Curtis(TE(ectronicaliy 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: Z Date of Disposition .3/9 111 Place of Disposition - t " ii m ar 2 ( L(address) W CO CC (section) ii` (t`s lot number) (grave number) 8 Name of Sexton or Person in Charge of Premises / 3/..AM (pleat print) WSignature £ A... Title lYtr�+'"4+ f g DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145 2b 114618 ;rtA141TIAA Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#