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O'Neil, Larry Gordon -# 30c- NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Larry Gordon O'Neil Male Date of Death Age If Veteran of U.S.Armed Forces, 03/27/2023 79 Years War or Dates Vietnam ZZ Place of Death Hospital,Institution or LIJ City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation p Manner of Death El Natural Cause Accident Homicide OSuicide n Undetermined ❑Pending Ui II I1 0 Circumstances Investigation QW Medical Certifier Name Title Courtney Diamond NP Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 167 0Burial Date Cemetery,Crematory or Facility Name 03/30/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed H and/or and/or Held N Hold Address 0 U. Date Point of U)❑Transportation p by Common Shipment Carrier Destination ODisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom F— Remains are Shipped,If Other than Above 5 Address CC LJ 0. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/28/2023 Registrar of Vital Statistics Megan Nolin(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: I!— ZDate of Disposition Li IN I Z3 Place of Disposition erksg / (address) W N Q (section) (lot number) stAdi (grave number) GName of Sexton or Person in Ch r of Premises �A'IN Lrt- Z (please print) W Signature ' Title (145/10 44 DOH-1555(o7/18)p 1 of 2 1 6J4. 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#