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Heydrick, Ernest A
LOF an ' NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permft Bureau of Vital Records Name First Middle Last Sex Ernest A.Heydrick Male Date of Death Age If Veteran of U.S.Armed Forces, 02/12/2023 69 Years War or Dates i_ Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death Natural Cause EAccident Homicide ESuicide Undetermined El Pending W Circumstances Investigation GMedical Certifier Name Title Marcille Labban 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 81 Burial Date Cemetery,Crematory or Facility Name 02/20/2023 Pine View Crematorium Entombment _ Address ©Cremation Queensbury Town,New York Donation 8❑Removal Date Place Removed and/or and/or Held H Hold Address CO 0 O. Date Point of CO❑Transportation Q by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment Date Cemetery Address 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 p— Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/13/2023 Registrar of Vital Statistics Megan Wolin(E(ectronicallySigned) (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: I- Z Date of Disposition 2f zi 173 Place of Disposition 1-- Atli.— ry- W 2 (address) W U) CC (section) il (lot nu er) (grave number) gName of Sexton or Person in Charge of P raises 4),IQ h itt Z / i (please print) RISignature / Title Clafrmrorl DOH-1555(07/18)p 1 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#