Barody, Alan Joseph ( LFI 1
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section �UCIa1 - Transit Permit
Name First Middle Last Sex
Alan Joseph Barody Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/07/22 War or Dates
Place of Death 20 Riverview B219 Hospital, Institution or
City,Town or Village Villaqe of South Glens Falls Street Address
Manner of Death 21 Natural Cause 0 Accident El Homicide 0 Suicide riUndetermined ri Pending
Circumstances Investigation
(34
Medical Certifier Name G kr,1 n _ �0 c �� Title a
Address -tf\ n )/�T , l� `7 gD
�' o Q u P ens
�`^ ; J Ater Number Ct
U
Death Certific a Filed c., District Number Register Reg 1
City, Town Village J b (en y s s Fc Its I
❑Burial e- ° Cemetery or Crematory
°Entomt> nt 11/09/22 Pine View Crematory
Address
®Cremation 21 Quaker Road Queensbury, NY 12804
Date Place Removed
Removal and/or Held
teRand/or Address
Hold
0. - Date Point of •
.0 Transportation Shipment
ifs by Common Destination
Carrier
0 Disinterment Date Cemetery Address
0 Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home MB Kilmer Funeral Home 01078
Address
136 Main Street South Glens Falls, NY 12803
Name of Funeral Firm Making Disposition or to Whom
ti Remains are Shipped, If Other than Above
2 Address ••
CC-
ill
a Permission is hereby granted to dispose of the human remains described as indicated.
Date Issued 11/07/22 Registrar of Vital Statistics /2404
(signature)
-, District Number 4524 Place Village of South Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 11 h a 1 Z t Place of Disposition 'FAA U �r-�
ress)
W
in
= J/(section) (lot number) c (grave number)
p Name of Sexton or Person in Charge of Premise / P L--- c J H
z
(pie se print)
Ut Signature Title ��E `���"�
(over)
DOH-1555 (02/2004)
I
Public Health Law Sec. 4145(2b) 0
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#