Hatch, Rodney Ray 410b'
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NEW YORKSTATE DEPARTMENT OF HEALTH \s• ,, Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Rodney Ray Hatch Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/27/2022 50 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Argyle Town Street Address 10 Heshe Way,Argyle Town, New York 12809
p Manner of Death I I Natural Cause EAccident CHomicide Suicide Undetermined Pending
`
Circumstances 1t^^'Investigation
WMedical Certifier Name Title
Robert Lemieux Coroner
Address
415 Lower Main Street, Hudson Falls Village,New York 12839
Death Certificate Filed Town Of Argyle District Number Register Number
City,Town or Village 5750 41
riBurial Date Cemetery,Crematory or Facility Name
07/28/2022 Pine View Crematorium
nEntombment Address
nCremation Queensbury Town,New York
El Donation
d Removal Date Place Removed
and/or and/or Held
- Hold Address
0
d Date Point of
U)nTransportation
by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
Reinterment
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
H Remains are Shipped,If Other than Above
2 Address
CC
W -
0- Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/28/2022 Registrar of Vital Statistics Shelley`Alckernon(Electronically Signed)
(signature)
District Number 5750 Place Town Of Argyle
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition 7,)../ xQy . Place of Disposition �jrn�e 1 /� thj �t-„t)1,94or%
2 V (aedress)
W
cr (section) T r `l (lot number) (grave number)
O Name of Sexton or Per •n in Charge of Premises `'CU J S u ��'S
Z (pkiase print)
W Signature fVe')
_ Title 612,r`'ct.4cir
DOH-1555(07/18)p 1 of 2
•
yR u e
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
1
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#