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Havens, Aaron Stacy 14 3cp k NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Aaron Stacy Havens Male Date of Death Age If Veteran of U.S.Armed Forces, 04/28/2023 53 Years War or Dates 1990-2011 Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ❑X Natural Cause Accident Homicide Suicide nUndetermined Pending W Circumstances Investigation U W Medical Certifier Name Title Christopher Smith 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 219 Burial Date Cemetery,Crematory or Facility Name 05/01/2023 Plne View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation nRemoval Date Place Removed and/or and/or Held t- Hold Address N 0 n. Date Point of N❑Transportation Shipment Q by Common Carrier Destination nDisinterment •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 F Remains are Shipped,If Other than Above * Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/01/2023 Registrar of Vital Statistics began Nohn(ECectronica(Cy 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: If— WDate of Disposition sly/Z3 Place of Disposition b/address/ W O (section) (lot number)' �"' � (grave number) /� \ '"" if Name of Sexton or Person in Charge of P emises r Z / /tease print) W Signature / Title 7- DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt 1 1 , , Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on huri3tpermit Official Funeral Directors Reg.or License#