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Girard, Gary Joseph
it 11 ZZ HEALTH - ` - Tr ansit YORK STATE DEPARTMENT OF Burial Transit Permit Bureau of Vital Records Name First Middle Last Sex Gary Joseph Girard Male Date of Death Age If Veteran of U.S.Armed Forces, 05/13/2021 70 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Putnam Town Street Address 16506 St.Rt.22,Putnam Town,New York 12861 LJ Manner of Death Pending � �Natural Cause �Accident �Homicide �Suicide ©Undetermined W Circumstances Investigation W Medical Certifier Name Title CI Wesley Perry Coroner Address 415 Lower Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed District Number Register Number City,Town or Village Putnam Station 5763 2 Burial Date Cemetery,Crematory or Facility Name 05/17/2021 Pine View Crematory Entombment Address Cremation Queensbury Town,New York Donation • Removal Date Place Removed and/or and/or Held - Hold Address 0 a Date Point of U) Li Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls, New York 12803 Name of Funeral Firm Making Disposition or to Whom I- Remains are Shipped,If Other than Above 2 Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/15/2021 Registrar of Vital Statistics Darlene Kfrr(ECectronicalTySigned) (signature) District Number 5763 Place Putnam Station, 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 S 1 Ig Ill Place of Disposition -►'t i�•�L L��...— (address) W Cl)CIC (section) zto t number/ 9 (grave number) Name of Sexton or Person in Charge of Premises � (Oil print/ lL Signature Title af.IA ittuit DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 01, 790 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#