Liddle, Michael J NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Michael John Liddle Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/11/2023 79 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Granville Town Street Address Slate Valley Center for Rehabilitation and Nursing
'p Manner of Death X❑Natural Cause nAccident ❑Homicide Suicide Undetermined ElPending
U Circumstances Investigation
W Medical Certifier Name Title
0 Jean Hams-Letts MD
Address
278 Vermont Route 149,Pawlet,Vermont 05775
Death Certificate Filed Town Of Granville District Number Register Number
City,Town or Village 5756 39
Burial Date Cemetery,Crematory or Facility Name
07/17/2023 Pine View Cemetery
Entombment Address
Cremation Queensbury Town,New York
Donation
6❑Removal Date Place Removed
and/or and/or Held
o Hold Address
0
d Date Point of
Cl) Transportation
by Common Shipment
Carrier Destination
IIIDisinterment 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
Remains are Shipped,If Other than Above
5 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/13/2023 Registrar of Vital Statistics Jenny Linda M Marte(h(E(ectronica(Ty Signed)
(signature)
District Number 5756 Place Town Of Granville
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 1 1 : a?� Place of Disposition ) 1 � e UG is slL,� .S,C ,1 ry /Y�/c;8o4
2 (address)
w -( h►ce,n 8l0
N (section) number) (grave number)
aName of Sexton or Person in Charge of Pre .ses 1n%C -�
pp (please print)
W 44;4Signature sC. 4. Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 012992
Receipt
Human remains of j ` ` delivered on , 20
•
e View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
Liddle
ram LUF
Lot No. 8 6-F
dress 10 Luzerne Rd. Queensbury Ny 12804 Section No.
vner Michael J. Liddle Plot Mohican
ate 6/17/94
Approx. 3 3 Superficial ft. @
cation Bounded North by Liddle , South by Kristel , East by Rymkewicz , West by Vacan
Trier Posts
marks
,ed No. (and changes) 2597
yment Record Paid in Full 6/17/94 ( S350 . 00 )
cord of Interments
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LIDDLE
NAME LIOF ge: 7]Michael J Liddle9
Lot Owner: Michael J Liddle
Lot# Mohican 86 F Grave# 1
Case: Concrete
Died: 7. 1 1 .2 3 Interred: 7. 1 7.2 3
Funeral Home: Carleton FH
Cemetery: Pine VIew