Rauch, Thomas Edward 41:it 4- ri'
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Last Sex
Name First Middle IL Male
Thomas Edward Rauch
Date of Death Age If Veteran of U.S.Armed Forces,
07/19/2022 76 Years War or Dates 1967-1970
Place of Death Hospital,Institution or
F'" Street Address Glens Falls Hospital
Z City,Town or Village Glens Falls Pending
W � Undetermined n g
p Manner of Death I^ I Natural Cause EAccident n Homicide nSuicideLIJ Circumstances ' Investigation
(,) Title
W Medical Certifier Name MD
O Marvin Davidowitz
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number383
City,Town or Village 5601
Burial Date Cemetery,Crematory or Facility Name
07/25/2022 Pine View Crematorium __
Entombment Address
PriCremation Queensbury Town,New York
CDonation
Date Place Removed
0(n Removal and/or Held -
N and/or
N
Hold Address
0
Date Point of
N FIT ran sportation Shipme,it
Q by Common
Carrier Destination
Date Cemetery Address
Disinterment
n Reinterment
Date Cemetery Address
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
F. Remains are Shipped,If Other than Above
Address
C
W
a" Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/25/2022 Registrar of Vital Statistics MeganWorin(ECectronicaUfySigned)
(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:
F -
W Date of Disposition ��-ZpZ�Place of Disposition (P�)�e w e, 4 O f
(address)
W
N (section) (lot number/ (grave number)
CC
O Name of Sexton or Person in Char of Pre ise . K e �g _'L ��
z (please print)
Z
Ill Signature Title a.� L .
c_1
DOH-1555(07/18)p 1 01-t
I
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# ,.' —