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Keech, Graham Robert NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records All Name First Middle Last Sex Graham Robert Keech Male Date of Death Age If Veteran of U.S.Armed Forces, 04/02/2023 42 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Argyle Town Street Address 3004 Aarons Way,Argyle Town,New York 12809 p Manner of Death Natural Cause InAccident Homicide InSuicide Undetermined ❑Pending UCircumstances Investigation. QMedical Certifier Name Title Robert Lemieux Coroner Address 415 Lower Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed Town Of Argyle District Number Register Number City,Town or Village 5750 21 [ lBurial Date Cemetery,Crematory or Facility Name 04/05/2023 Pine View Crematorium ri Entombment Address ©Cremation Queensbury Town,New York Donation OZ❑Removal Date Place Removed and/or and/or Held H Hold Address 0 d. Date Point of U)nTransportation p by Common Shipment Carrier Destination nDisinterment Date Cemetery Address nReinterment 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 I.— Remains are Shipped,If Other than Above 5 Address CC W • O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/05/2023 Registrar of Vital Statistics Shelley fMckrnon('Electronically 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 on: I- �/ W Date of Disposition 7" 7Zz3 Place of DiL position P aL e ) Ter (addres W U) Q A (section) (jnumer (grave number) 0 Name of Sexton or Person in Charge of Pr miles /�p)/ .JD f c� Z (please print) W Signature Title 49,Q,✓'— DOH-1555(07/18)p 1 of 2 V amal.11.1.1.61 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial petit Official Funeral Directors Reg.or License#