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Hubinger, John Carleton ittPg NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John Carleton Hubinger Male Date of Death Age If Veteran of U.S.Armed Forces, 08/11/2021 75 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Granville Town Street Address Slate Valley Center for Rehabilitation and Nursing W Manner of Death Pending W ©Natural Cause �Accident �Homicide �Suicide Undetermined V Circumstances Investigation W Medical Certifier Name Title O Leonard Gelman MD Address 10421 State Route 40,Granville Town,New York 12832 Death Certificate Filed District Number Register Number City,Town or Village Granville 5756 65 Burial Date Cemetery,Crematory or Facility Name 08/16/2021 Pine View Crematorium EIEntombment Address X❑Cremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held - Hold Address 0 U)) ❑Transportation Date Point of by Common Shipment Carrier Destination 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 1— Remains are Shipped,If Other than Above 5 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/16/2021 Registrar of Vital Statistics Jenny Linda M MarteCCe(E(ectronica(Cy Signed (signature) District Number 5756 Place Granville, 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 gInIU Place of Disposition egit 40�_ 2 !address) W CC (section) (lot number) (grave number) • Name of Sexton or Person in Charge of Premis '1 t 4 1. � 444+T Z '? (plse print) lL Signature Title ('w1 DOH-1555(07/18)p 1 of 2 31fi47 Public Health Law Sec. 4145(2b) Receipt Human remains of I. delivered on , 207' Pine View Cemetery Representing the funeral home named orkburialyermit Official Funeral Directors Reg.or License# /