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French, Douglas Alfred II3s8 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital.Records Name First Middle Last Sex Douglas Alfred French Male Date of Death Age If Veteran of U.S.Armed Forces, 04/17/2021 77 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital VcManner of Death ©Natural Cause E Accident Homicide ElSuicide ❑Undetermined Pending Circumstances Investigation WW Medical Certifier Name Title GI Melody Long PA Address 100 Park Street,Glens Falls,New York 12801 Death Certificate Filed District umber Register Number City,Town or Village Glens Falls 5601 182 ❑Burial Date Cemetery,Crematory or F ity Name 04/20/2021 Pine View Crematoriur ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation 8 ❑Removal Date Place Removed and/or and/or Held H Hold Address 0 N ❑Transportation Date Point of p 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 Remains are Shipped,If Other than Above M Address w a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/20/2021 Registrar of Vital Statistics cNp ertAndrew Curtis(ECectronicaCCy 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: W Date of Disposition � Z( I 71 Place of Disposition IL ,Cjt 06-- (address) W CC (section) (lot number) (grave number) 8 Name of Sexton or Person in Charge of emises /it, L t Z pdF W Signature `.�i Title Clqrie. DOH-1555(07/18)pi of 2 Public Health Law Sec. 4145(2b) 6 Receipt 1 Human remains of delivered on , 20 1 t' 1 Pine View Cemetery Representing the funeral home named,on burial permit Official Funeral Directors Reg.or License#! 'ic.,•• I i