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Girard, John Kevin ' 17 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John Kevin Girard Male Date of Death Age If Veteran of U.S.Armed Forces, 10/21/2021 65 Years War or Dates F. 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 Suicide Undetermined Pending UJ Circumstances Investigation W Medical Certifier Name Title Marvin Davidowitz MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 470 ▪Burial Date Cemetery,Crematory or Facility Name 10/28/2021 Pine View Crematorium EEntombment Address Cremation Queensbury Town,New York ▪Donation © El Removal Date Place Removed and/or and/or Held t Hold Address 0 d Date Point of V) ❑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 Remains are Shipped,If Other than Above Address W ▪ Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/28/2021 Registrar of Vital Statistics Ruben Andrew Curtis(Ehctronica1Ty 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 10-30—2e2 I Place of Disposition ;A)e v1814f Cr-em4-10--YY 2 (address,a W (section) // (lot Imbed (grave number) !7 o 0 Name of Sexton or Person in Cha f Premises. (��/h/D� h/UC> Z c (please print) W Signature /4 Title ore.re `kty DOH-1555(07/18)p i of 2 k Public Health Law Sec. 4145(2b) 1 1 Receipt Human remains of delivered on , 20 1 ' IPine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#