Graves, Daniel Joseph ...: -
(IiF) a. iiii,i
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Daniel Joseph Graves Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/14/2023 42 Years War or Dates
E.. Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
LL Manner of Death pi ā ri ā Undetermined []Pendin
p Natural Cause Accident I I Homicide Suicide I ' g
lL Circumstances Investigation
U
W Medical Certifier Name Title t'
CI Asim Chaudry MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 88
Burial Date Cemetery,Crematory or Facility Name ,
02/16/2023 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
grlRemoval Date Place Removed
and/or and/or Held
H Hold Address
U)
0
a Date Point of
U)nTransportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Date Cemetery Address
E 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
Fā Remains are Shipped,If Other than Above
5 Address
CC
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/16/2023 Registrar of Vital Statistics Megan.Notin(Electronically Signed)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Iā
WDate
Date of Disposition Z1("1 1 Z3 Place of Disposition .- 'L,tL / i' .
2 (address)
W
U)
Q (section) /1 (lotumber) (grave number)
0 Name of Sexton or Person in Charge of Pr mises L if
Z (Jr/ease print)
W Signature Title Cri`'MMN/f
DOH-1555(07/18)p i of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#