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Skirkanich, Ronald Peter � � # 572 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Ronald Peter Skirkanich Male Date of Death Age If Veteran of U.S.Armed Forces, 07/14/2022 69 Years War or Dates E— Place of Death Hospital,Institution or Z City,Town or Village Hartford Town Street Address 208 Pope Hill Road,Hartford Town,New York 12809 W Manner of Death W El Natural Cause nAccident El Homicide Suicide Undetermined ❑Pending U Circumstances Investigation LUI Medical Certifier Name Title 0 David Foote MD Address 340A Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed Town Of Hartford District Number Register Number City,Town or Village 5759 Burial Date Cemetery,Crematory or Facility Name 07/19/2022 Pine View Crematorium Entombment Address Cremation Queensbury Town,New York Donation ©nRemoval Date Place Removed and/or and/or Held H Hold Address N 0 a Date Point of t/)OTransportation p by Common Shipment Carrier Destination EiDisinterment Date Cemetery Address 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 i— Remains are Shipped,If Other than Above 2 Address Q W a` Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/19/2022 Registrar of Vital Statistics (Denise 4'etteys(ECectronicatty Signed) (signature) District Number 5759 Place Town Of Hartford I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition 1170 ht Place of Disposition fir..VI....., 47:1, -. g, (address) W CO Q (section) (lot number) (grave number) gName of Sexton or Person in Charge of remises toilL_.1 et Z /`�� ase print) ,/� W Signature LJ -��� Title �y(�/�1 �'d(L DOH-1555(07/18)p i of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 '.ne View Cemetery Representing the funeral home named on burial permit Funeral Directors Reg.or License#