Morehouse, Gilbert Carson „LF .11 enj
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Gilbert Carson Morehouse Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/07/2022 67 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare
W Manner of Death Undetermined Pending
[]Natural Cause []Accident []Homicide []Suicide []
W Circumstances Investigation
(.) Title
W Medical Certifier Name
CI Leah Terry NP
Address
4573 4573 NY-40,Argyle Town,New York 12809
Death Certificate Filed Town Of Argyle District Number Register Number
City,Town or Village 5750 64
[]Burial Date a':/` Cemetery,Crematory or Facility Name
12/12/2022 Pine View Crematorium
[]Entombment Address
i; EICremation Queensbury/Town,New York
Donation
Z Date Place Removed
LI Removal and/or Held
f- and/or -
N
Hold Address
0
Date Point of
N❑Transportation Shipment
p by Common
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
N Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/12/2022 Registrar of Vital Statistics Shelley Mlckernon(ECectronicalTy 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--it on:
~ +f Place of Disposition AIL (34.r.��
W Date of Disposition I l obt P (address)
W
Cl)Cr (section) (lot number) (grave number)
O 9,.. m tt
O Name of Sexton or Person in Charge o Premises n.
Z Z.-
(p ase print)
W
SignatureTitle G trAm'ilk'
DOH-1555(07/18)p l of 2
I
r-.., . , i .
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on bgriil permit
Official Funeral Directors Reg. or License# ` '