Loading...
Parrott, Richard J NEW YORK STATE DEPARTMENT OF H EALTH ell Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Richard J.Parrott Male Date of Death Age If Veteran of U.S.Armed Forces, 02/12/2022 93 Years War or Dates Place of Death Hospital,Institution or City,Town or Village Fort Ann Town Street Address 1133 County Route 16, Fort Ann Town, New York 12827 ILI a Manner of Death © Natural Cause ❑Accident ❑ Homicide ❑Suicide 0 Undetermined Pending ILI Circumstances Investigation 0 Medical Certifier Name Title David Foote MD Address 340A Main Street, Hudson Falls Village,New York 12839 Death Certificate Filed District Number Register Number City,Town or Village Fort Ann 15754 6 ❑Burial Date Cemetery,Crematory or Facility Name 02/14/2022 Pineview Crematorium Entombment Address 0 Cremation Queensbury Town,New York Donation Removal Date Place Removed and/or and/or Held m' Hold Address CA Li Transportation Date Point of ES by Common Shipment Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address 0 Reinterment Permit Issued to Registration Number Name of Funeral Home Mason Funeral Home 01117 Address 18 George St Po Box 277,Fort Ann,New York 12827-0277 Name of Funeral Firm Making Disposition or to Whom fr. Remains are Shipped,If Other than Above ,X Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/14/2022 Registrar of Vital Statistics Barbara J Winchell (Electronically Signed) (signature) District Number 5754 Place Fort Ann, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IH �J Date of Disposition x Place of Disposition Fi.t.b t 7 4r�•-122 address) W c (section) (lot number) S.:m.4h- li (grave number) (�8` Name of Sexton or Person in Charge of Premises 6(plea print) Signature Title DOH-1555(07/18)pi of 2 i " i. 5 rT 41. 3 Public Health Law Sec. 4145(2b) Receipt Human remains of r delivered on f,' , 20 • Pine View Cemetery Representing the funeral home named oil burial permit Official Funeral Directors Reg.or License#