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Green, Riley Chance 6 , NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Riley Chance Green Male Date of Death Age If Veteran of U.S.Armed Forces, 09/05/2021 22 Years War or Dates H Place of Death Hospital,Institution or W City,Town or Village Cohoes Street Address 180 Columbia Street,Cohoes,New York 12047 10 Manner of Death ❑Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ©Pending Circumstances Investigation W Medical Certifier Name Title O Antonio Sturges Coroner Address 175 Green Street,Albany,New York 12202 Death Certificate Filed District Number Register Number City,Town or Village Cohoes 0102 108. ❑Burial Date Cemetery,Crematory or Facility Name 09/07/2021 Pine View Crematorium ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation IS ❑Removal Date Place Removed and/or a: and/or Held - Hold Address 0 O. ❑ Date Point of co Transportation p by Common Shipment Carrier Destination El 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 H. Remains are Shipped,If Other than Above 2 Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/07/2021 Registrar of Vital Statistics Lori Ann Tando(ECectronicaCCy Signed) (signature) District Number 0102 Place Cohoes, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ZplL W Date of Disposition t $1 14 Place of Disposition Fa 2 (address) W CC (section) I(lot number) (grave number) g Name of Sexton or Person in Charge of Pre 'ses /ha L )4i&4ST Z (pleas print) �* W Signature Title ` ''* DOH-1555(07/18)p 1 of 2 t. atry a ..^ Public Health Law Sec. 4145(2b) Receipt 1, Human remains of = s '.° delivered on , 20 ` Pine View Cemetery Representing the funeral home named pnburi,al-permit Official Funeral Directors Reg.or License# `r