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Buchanan, John Rayburn
NEW YORK STATE DEPARTMENT OF HEALTH C Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John Rayburn Buchanan Male Date of Death Age If Veteran of U.S.Armed Forces, 05/14/2023 93 Years War or Dates ZPlace of Death Hospital,Institution or Ili City,Town or Village Queensbury Town Street Address 66 Reardon Road,Queensbury Town,New York 12804 p Manner of Death ❑^ Natural Cause Accident Homicide OSuicide Undetermined Pending al U Circumstances Investigation Wp Medical Certifier Name Title John Sawyer MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 75 Burial Date Cemetery,Crematory or Facility Name 05/16/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation 6❑Removal Date Place Removed F„ and/or and/or Held - Hold Address 0 Et. Date Point of N❑Transportation p by Common Shipment Carrier Destination ODisinterment 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 N Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/16/2023 Registrar of Vital Statistics CarolineWififegarde Barber(ECectronicaCCySigned) (signature) District Number 5657 Place Town Of Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: �l W~ TS— �'T�'—� Date of Disposition Ski 173 Place of Disposition 2 ess) W U) CC (section) A (lot number) (grave number) 8 Name of Sexton or Person in Charge of mises ►.- 141 Z ease print) IL Signature Title 6411 018'? DOH-1555(07/18)p 1 of 2 1 • - _.. Public Health Law Sec. 4145(2b) Receipt Y Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial,permit Official Funeral Directors Reg.or License# ..