Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Draves, Roger
Q , 4io,O NEWYORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Roger Draves Male Date of Death Age If Veteran of U.S.Armed Forces, 11/28/2021 74 Years War or Dates 1967-1973 Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital ILI p Manner of Death ©Natural Cause Accident Homicide El Suicide ❑Undetermined Pending U Circumstances Investigation Q Medical Certifier Name Title 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 554 Burial Date Cemetery,Crematory or Facility Name 12/01/2021 Pineview Crematory ❑Entombment Address ElCremation Queensbury Town,New York 0 Donation Removal Date Place Removed p and/or and/or Held N Hold Address 0 0. Date ' Point of co 11 Transportation by Common Shipment Carrier Destination El Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home John F X Mckeon&Son Inc 00890 Address 3129 Perry Ave,Bronx,New York 10467 Name of Funeral Firm Making Disposition or to Whom F— Remains are Shipped,If Other than Above a Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/30/2021 Registrar of Vital Statistics Wp6ert Andrew Curtis(ECectronicallySigned /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 171 b )71 Place of DispositionILI ,,c 1` 2 (address) W U) CC (section) I (lot number) (grave number) gName of Sexton or Person in Charge of mises /11 drt 4-�-� S vlij it Z /p e print/ Ui Signature Title (RINI TOP DOH-1555(07/18)p i of 2 Pn 3q"7 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#