Maule, Tobin Bateson 3
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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Tobin Bateson Maule Male
Date of Death Age If Veteran of U.S.Armed Forces,
05/06/2022 71 Years War or Dates 1977-1982
Place of Death Hospital,Institution or
ZCity,Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death a Natural Cause Accident �Hornicide Suicide Undetermined Pending
V Circumstances Investigation
EMedical Certifier Name Title
Shahid Ahmed MD
Address
100 Park St,Glens Falls,New York 12801
DeaAth Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 253
Burial Date Cemetery,Crematory or Facility Name
05/072022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
F Hold Address
N
2 Date Point of
N EiT ran sportation
Q by Common Shipment
Carrier Destination
ID
Disinterment
Date Cemetery Address
ED
Rei me rment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Barton-Mcdemrott Funeral Home Inc 00141
Address
9 Pine St,Chestertown,New York 12817
Name of Funeral Firm Making Disposition or to Whom
i— 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 05/06/2022 Registrar of Vital Statistics SfganYotn(EketsnnrcaQy,Srgn1QJ
(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:
Date of Disposition 5.111 ZZ Place of Disposition ?ANL C).tr'
W (address)
W
Q (section) �-�% �rH
Rqt number) (grave number)
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GName of Sexton or Person in Charge of Premises �//�Iel1
z /plc se print) /
W PP
Signature tY Z Title ` kfirie
DOH 1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 19
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named/on burial permit
Official Funeral Directors Reg.or License#