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Goodman Jr., Warren William NEW YORK STATE DEPARTMENT OF HEALTH w Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Warren William Goodman Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, 12/20/2021 59 Years War or Dates 1978-1981 Place of Death Hospital,Institution or z City,Town or Village Hudson Falls Village Street Address 78 1/2 Main Street, Hudson Falls Village,New York 12839 W `p Manner of Death ©Natural Cause ❑Accident ❑Homicide Suicide ❑Undetermined El Pending Circumstances Investigation W Medical Certifier Name Title John Aiken Coroner Address 40 Burquist Road,Fort Ann Town,New York 12827 ti Death Certificate Filed District Number Register Number City,Town or Village Hudson Falls Village 57264, 37 Burial t Date Cemetery,Crematory or Facility Name 12/21/2021 Pine View Crematorium Entombment Address Cremation Queensbury Town,New York IDDonation ZO 0 Removal Date Place Removed and/or and/or Held - Hold Address N 0 Date Point of Cl) ❑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 F— Remains are Shipped,If Other than Above a Address CC W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/21/2021 Registrar of Vital Statistics Cynthia BarcCin(EfectronicalTySigned) (signature) District Number 5726 Place Hudson Falls Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition 17.122.12) Place of Disposition ;� �` (,.hos,o--, 2 (address) W tl) CC (section) L YI (lot number) (grave number) gName of Sexton or Person in Charge of Premises L rs �,Cor tt Z (p!e se print) W Signature ( Title (PS id,A DOH-1555(o7/18)p t of 2 I _ #asuaar-I JO•2ag sJoioan[Q i .iaun,d IP?a!JJO iruuad offiiii4 uo pauxnu auioq Ie.zaunj aqp 27u7soidag J JaaauzaJ ma!A auid I i OZ ` T uo pa.zaniiap . ., T , r.k Jo suluwa.z umu nH 1 +t 1 ldiaaag '.; (gZ)S7i7 'DOS MWJ u;iPOH DTi9nd L ... . 4