Hammond, Gary Sb
Z
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last
Gary Hammond Sex
Date of Death Male
Age If Veteran of U.S.Armed Forces,
07/14/2022 74 Years War or Dates 1968-71
Place of Death Hospital,Institution or
tuZ City,Town or Village Hudson Falls Village Street Address 1 St.Pauls Drive 1G,Hudson Falls Village,New York 12839
CI Manner of Death ❑Natural Cause Accident Homicide 0Suicide Undetermined Pending
W
U; Circumstances Investigation
#1 Medical Certifier Name Title
�] James Gariepy Coroner
Address
19 East Broadway,Salem Town,New York 12865
Death Certificate Filed Village Of Hudson Falls District Number Register Number
City,Town or Village 5726 33
Burial Date Cemetery,Crematory or Facility Name
® 07/15/2022 Pineview Crematorium
Entombment Address
Cremation Queensbury Town,New York
❑Donation
flEl Removal Date Place Removed
and/or and/or Held
5 Hold Address •
A. Date Point of
U) Transportation
15 by Common Shipment
Carrier Destination
Date Cemetery Address
❑Disinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Mason Funeral Home 01117
Address
18 George St Po Box 277,Fort Ann,New York 12827-0277
Name of Funeral Firm Making Disposition or to Whom
p... Remains are Shipped,If Other than Above
+ Address
tt
ILI
A. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/15/2022 Registrar of Vital Statistics Cynthia A Bardln(Electronically Signed)
(signature)
District Number 5726 Place Village Of Hudson Falls
9
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2 Date of Disposition 7/4— Place of Disposition {�oe V..'e) C,-eirt4-1.0,LH
f (address)
�}
ta
tfl Q (section) 1 (lot numb r) (grave number)
Name of Sexton or Person in Charge Premises Jc'i4 Yvc,.' e1 (41=r)
Z
�� (please int/
Ili
Signature �?f Title 0f�z^t1,e �—
DDH-4555\ h%\ploi 2
C: P,
Public Health Law Sec. 4145(2b)
Receipt
/, „/./Human remains of 7 ri 1 , delivered on /-,' , 20
=
Pine View Cemetery Representing the funeral home named prilDuf)al-per9tlit
,
Official Funeral Directors Reg. or License# '