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Parker, Alfred Robert Jr. NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Alfred Robert Parker Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, 02/04/2022 78 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Hudson Falls Village Street Address 147 John Street, Hudson Falls Village, New York 12839 Manner of Death Pending O © Natural Cause �Accident n Homicide �Suicide �Undetermined � Circumstances Investigation W Medical Certifier Name Title CI Curtis Gedney MD Address 454 Glen Street,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Hudson Falls Village 5726 3 Burial Date Cemetery,Crematory or Facility Name 02/08'2022 Pine View Crematorium riEntombment Address I^I Cremation Queensbury Town,New York Donation CRemoval Date Place Removed and/or and/or Held Hold Address 0 0- Date Point of Cl) C Transportation p by Common Shipment Carrier Destination Date Cemetery Address C Disinterment 121 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 2 Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/07/2022 Registrar of Vital Statistics Cynthia 4:Bardin(Elect runica(1ySrgned-) (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 rr Place of Disposition 2 (address) U3CC (section) (lnt number) (grave number) • Name of Sexton or Pers in Charge of Premises Ter?)vy ScS.6(4'5 Z (please print) C Signature _ Title C—��""Q G ----- DOH-1555(0748)p i of 2 Public Health Law Sec. 4145(2b) s3a Receipt Human remains of Li t { delivered on , 20 ' Pine View Cemetery Representing the funeral home named on burial permit ' Official Funeral Directors Reg.or License#