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Higgins, Thomas Michael ti 321 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Thomas Michael Higgins Male Date of Death Age If Veteran of U.S.Armed Forces, 04/04/2023 67 Years War or Dates F Place of Death Hospital,Institution or WCity,Town or Village Thurman Town Street Address 59 Athol Road,Thurman Town, New York 12810 p Manner of Death ❑^ Natural Cause DAccident Homicide ESuicide Undetermined riPending W U Circumstances Investigation W Medical Certifier Name Title O David Foote MD Address 340A Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed Town Of Thurman District Number Register Number City,Town or Village 5659 3 Burial Date Cemetery,Crematory or Facility Name 04/11/2023 Pine View Crematorium Entombment _ Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 O. Date Point of U)❑Transportation Shipment p by Common - Carrier Destination Disinterment Date Cemetery Address Reinterment 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 1— Remains are Shipped,If Other than Above i Address CIC a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/10/2023 Registrar of Vital Statistics Cynthia c,7fyie(E(ectronicaCTy Signed) (signature) District Number 5659 Place Town Of Thurman I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition gill 1ll Place of Disposition `r,uv 2 (address) W NCC (section) (lot number) (grave number) 4,.. Name of Sexton or Person in Charge of Premises i"' in z (p ase print) WI,P Title �F�+'� i?�vt Signature DOH-1555(07/18)p 1 of 2 • ► tom.?.. 68 f'U 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#