Loading...
Hinchliffe, John Wiliam . - ,# 83�6 n NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John William Hinchliffe Male Date of Death Age If Veteran of U.S.Armed Forces, 10/03/2021 81 Years War or Dates 1959-1962 �.. Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ©Natural Cause ❑Accident Homicide D Suicide ❑Undetermined ❑Pending 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 432 ❑Burial Date Cemetery,Crematory or Facility Name 10/05/2021 Pine View Crematorium Entombment Address lCremation Queensbury Town,New York Donation ZO ❑Removal Date Place Removed and/or and/or Held �- Hold Address 0 O. Date Point of N j Transportation p 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 I—. 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 10/04/2021 Registrar of Vital Statistics 2WertAndrew Curtis(E(ectronica1ty 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— Z Date of Disposition MI51Z1 Place of Disposition W (address) IlI CC (section) / (lot numbe (grave number) a0G C t —. i++�n Name of Sexton or Person in Charge of Premis l Z (please print) lL Signature Title DOH-1555(o7/18)p t of 2 0 : 57Q3 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# f f `