Loading...
Allen11, Howard Clyde NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Howard Clyde Allen 2nd Male Date of Death Age If Veteran of U.S.Armed Forces, 05/06/2021 86 Years War or Dates Army F. Place of Death Hospital,Institution or City,Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending UCircumstances Investigation NMedical Certifier Name Title CC]] Matthew Loftus PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 ❑Burial Date Cemetery,Crematory or Facility Name 05/08/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury,New York ❑Donation SEl Removal Date Place Removed — and/or and/or Held — Hold Address CO 0 O. 1-1 Date Point of to ❑Transportation p by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address Date Cemetery Address ❑Reinterment Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 2 Address a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/07/2021 Registrar of Vital Statistics WgbertAndrew Curtis(Efectronicaffy 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: Date of Disposition 3=4 ,"1/ Place of Disposition P` e I eb J ('ejyj„�4,r 2 (addressP W Q (section) J hive? /llot norther) (grave number) 8 Name of Sexton or Person in Charg f Premises Zlilii ',✓cr h✓dd 2 (please print) W Signature / <'7 Title ���De19. 401-1— DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) - 7 l - Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#