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Ringer, Alan William t in] NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Alan William Ringer Male Date of Death Age If Veteran of U.S.Armed Forces, 05/31/2021 54 Years War or Dates 1985-1990 �.. Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ©Natural Cause El Accident Homicide Suicide Undetermined 0 Pending W V Circumstances Investigation Q Medical Certifier Name Title 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 229 Burial Date Cemetery,Crematory or Facility Name 06/07/2021 Pine View Crematorium El Entombment Address ElCremation Queensbury Town,New York Donation Removal Date Place Removed and/or and/or Held H Hold Address • d Date Point of Cl) ❑Transportation p by Common Shipment Carrier Destination Ei 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 5 Address ft W 0' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/02/2021 Registrar of Vital Statistics Roden Andrew Curtis(Electronically 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: F— W Date of Disposition 6 I Place of Disposition t+1� PL, 2 (address) W N CC (section) �/q (lot number) (grave number) Name of Sexton or Person in Charge of Pre ses t A°'s '��f qy n-(t� `Z (pase print) Signature Title CiViNfralf DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014 38 Receipt Human remains of i delivered on , 20..? Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#