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Austin, Raymond Arthur NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Raymond Arthur Austin Male Date of Death Age If Veteran of"ti.S.Armed Forces, 01/07/2022 74 Years War or Dates i_ Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W p Manner of Death ©Natural Cause 0 Accident D Homicide ❑Suicide\ Undetermined n Pending U Circumstances Investigation W Medical Certifier Name Title Q Gwendolyn Morris-Dickinson PA Address / 100 Park St,Glens Falls,New York 12801 Death Certificate Filed Register Number City,Town or Village Glens Falls 5601 22 ❑Burial Date Cemetery, matory or Facility Na 01/11/2022 Pine View Crematorium 0 Entombment Address X❑Cremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 d 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 H Remains are Shipped,If Other than Above 5 Address CC a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/10/2022 Registrar of Vital Statistics fegan No(in(E(ectronica((ySigned) (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: H f Date of Disposition 1 I►312 Z Place of Disposition F.,t1L , -p,�LU 2 /a W LA CC (section) (lot number) C- (grave number) O Name of Sexton or Person in Charge of Pr ises l�r �Wt��f Z /please rint/ W Signature Title ` �� DOH-1555(07/18)p 1 of 2 554 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#