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Hogan, John James
56 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John James Hogan Male Date of Death Age If Veteran of U.S.Armed Forces, 07/02/2021 78 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital Manner of DeathPending ID © Natural Cause ['Accident �Homicide �Suicide �Undetermined W Circumstances Investigation W Medical Certifier Name Title CI Gamal Khalifa MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 268 Burial Date Cemetery,Crematory or Facility Name 07/06/2021 Pine View Crematory Entombment Address 0 Cremation Queensbury Town,New York ❑Donation OZ Removal Date Place Removed and/or and/or Held F Hold Address 0 G. Date Point of N ❑Transportation Shipment p 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-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/06/2021 Registrar of Vital Statistics 2i!g6ertAndrew 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: �( Z Date of Disposition 7I 174 Place of Disposition 4?'JL. 0�..._► 2 (address) W CC CC (section) ,/Qotnumber) (grave number) aName of Sexton or Person in Charge of Premis r` � �$4l �* Z (pleas print) PA W Signature Title C �t DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) 014911 Receipt Human remains of delivered on , 20 1 Pine View Cemetery Representing the funeral home named on burialpermit Official Funeral Directors Reg.or License#