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Palmer, Vernon Richard NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Vernon Richard Palmer Male Date of Death Age If Veteran of U.S.Armed Forces, 07/03/2021 63 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Greenwich Town Street Address 5330 County 113 Route Lot 40,Greenwich Town,New York 12834 W Manner of Death Undetermined 1:1Pending © Natural Cause Accident Homicide Suicide W Circumstances Investigation U Ill Medical Certifier Name Title Robert Lemieux Coroner Address 415 Lower Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed District Number Register Number City,Town or Village Greenwich 5757 16 Burial Date Cemetery,Crematory or Facility Name 07/07/2021 Pine View Crematorium ElEntombment Address ElCremation Queensbury Town,New York ElDonation Date Place Removed F- Removaland/ and/or Held or Hold Address 0 Date Point of (/) ❑Transportation Shipment Es by Common Carrier Destination Date Cemetery Address Disinterment Date Cemetery Address Reinterment 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 Address CC W 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/06/2021 Registrar of Vital Statistics N.im6er(y Whe(an(E(ectronica(Cy Signed) (signature) District Number 5757 Place Greenwich, 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 /11 RI Place of Disposition ef-i7AxL (address) W CC CC (section) (lot number) (grave number) Name of Sexton or Person in Charge Premises z tease print) Z 2 111 Signature Title Cl��'W� DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) 01 4(.118 1 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#