Steele, David Allen le) 4- 76Z)
NEW YORKSTATE DEPARTMENTOFHEALTH Burial -Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
David Allen Steele Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/18/2022 69 Years War or Dates
IH Place of Death Hospital,Institution or
City,Town or Village Hudson Falls Village Street Address 31 Martindale Terrace,Hudson Falls Village,New York 12839
O0
Manner of Death EINaturalCause Accident Homicide ❑Suicide ❑Undetermined El
W Circumstances Investigation
WMedical Certifier Name Title
0 John Aiken Coroner
Address
40 Burquist Road,Fort Ann Town,New York 12827
Death Certificate Filed Village Of Hudson Fags District Number Register Number
City,Town or Villa, 5726 17
Burial Date Cemetery,Crematory or Facility Name
Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
O❑Removal Date Place Removed
and/or and/or Held
pN Hold Address
0
d Date Point of
fA❑Transportation
p 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 Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped,If Other than Above
2 Address
CIC
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03722/2022 Registrar of Vital Statistics Cynthia,%/Bardin(EketronicallySW
(signature/
District Number 5726 Place Village Of Hudson Fads
I certify that the remains of the decedente identified above were disposed of in accordance with this permit on:
WDate of Disposition ) 044 Y�n Place of Disposition r ( tlf�._
2 (address)
W
N
CC (section) (lot number) c (grave number)
8 Name of Sexton or Person in Cha a of Premise th fsl L „S% J(ir
please print/
z rgMtrik.
Signature Title
DOH 1555(07/18)p 1 of 2
----Ki l
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#