Alway, Joseph A Zi l
NEW YORK STATE DEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Joseph A Aiwsy Male
Date of Death Age If Veteran of U.S.Armed Forces,
03604/2022 85 Years War or Dates 1955-1957
H Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
2iManner of Death El Natural Cause Accident 0 Homicide ❑Suicide ❑Undetermined ❑Pending
Ul
0 Circumstances Investigation
M Medical Certifier Name Title
Asim Chaudry MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 145
Burial Date Cemetery,Crematory or Facility Name
031
0712
O2
2 Pine View Crematorium
Entombment Address
Cremation Queensbuty Town,New York
Donation
t1Removal Date Place Removed
and/or and/or Held
COp Hold Address
0
Transportation Date Point of
by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
pReinterment
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Fats,New York 12839
Name of Funeral Firm Making Disposition or to Whom
i- Remains are Shipped,If Other than Above
5 Address
CC
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/07/2022 Registrar of VitalStatistics Alvan NOGrr('F4itnmic-a.fy.S ttee4
/signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition 319(Z Z. Place of Disposition .e- ("
s /77.4-1C_(address)
W
(section) (lot nu`mber) (grave number)
2 Name of Sexton or Person in Cha f Premises dn, /4Nr{ti(
z / (plee print) /` c�)
W Signature C%!l Title G Rfll�
DOH-1555(07/18)p 1 of 2
� �- is"
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#