Hall, Ronald O,Neil [OF II 11?6-
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Ronald O'Neill Hall Male
Date of Death Age If Veteran of U.S.Armed Forces,
05/20/2022 80 Years War or Dates
i_ Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
MI
p Manner of Death Ell Natural Cause lilAccident El Homicide nSuicide Undetermined ❑Pending
W Circumstances Investigation
U
W Medical Certifier Name Title
CI Mathew Varughese DO
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 281
Burial Date Cemetery,Crematory or Facility Name
05/23/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Z❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
G. Date Point of
V)lilTransportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
nDisinterment
ri Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
f-. Remains are Shipped,If Other than Above
"g Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/23/2022 Registrar of Vital Statistics Megan North(ECectronica(CySigned)
(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:
IF—
Z Date of Disposition SIZIv(ZZ Place of Disposition ....Ftv,,...., [ A-or-. ..
IIJ
2 (address)
W
N
CC (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises g(4.41(i—, At
Z (pe print)
alSignature �%' Title � �
DOH-1555(07/18)p 1 of 2
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#