White, Ronald Boyd NEWYORKSTATEDEPARTMENTOFHEALTH C Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Ronald Boyd White Male
Date of Death Age If Veteran of U.S.Armed Forces,
06/03/2022 85 Years War or Dates 1960-63
i_ Place of Death Hospital,Institution or
WCity,Town or Village Hudson Falls Village Street Address 20 Jones Avenue,Hudson Falls Village,New York 12839
p Manner of Death El Natural Cause Accident 0 Homicide Suicide FlUndetermined n Pending
W
U Circumstances II ''Investigation
W Medical Certifier Name Title
CI Darci Gaiotti-Grubbs MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed Village Of Hudson Falls District Number Register Number
City,Town or Village 5726 29
Burial
H
Date Cemetery,Crematory or Facility Name
06/06/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
611IRemoval Date Place Removed
and/or and/or Held
H Hold Address
N
0
O. Date Point of
U)OTransportation Shipment
p by Common
Carrier Destination
o
Disinterment
Date Cemetery Address
Date Cemetery Address
0 Reinterment
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
2 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/06/2022 Registrar of Vital Statistics Cynthia A Bardin(Electronically Signed)
(signature)
District Number 5726 Place Village Of Hudson Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
~ if-u-�
2 Date of Disposition (p1(p1 et Place of Disposition �,�,�)Ill (address
W v--__,{7�
U)CC (section) A (lot prumber) ...c '^ (grave number)
L.,
Name of Sexton or Person in Charge of mises 4v
/p(le1e print)
Z C1 ✓►Tilt e
W Signature Title
DOH-1555(o7/18)p 1 of 2
O L 7 i 6
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#