Loading...
Clendon, Aage Harold NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Aage Harold Clendenin Male Date of Death Age If Veteran of U.S.Armed Forces, 06/01/2023 74 Years War or Dates F... Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 24 Big Boom Avenue,Queensbury Town,New York 12804 tL Manner of Death Undetermined Pending 0 Natural Cause Accident Homicide Suicide W Circumstances Investigation 0 W Medical Certifier Name Title O Timothy Murphy Coroner Address 52 Haviland Avenue,Glens Falls,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 85 Burial.a Date Cemetery,Crematory or Facility Name 06/05/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 a Date Point of U)❑Transportation 0 by Common Shipment Carrier Destination Date Cemetery Address Disinterment Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/05/2023 Registrar of Vital Statistics Caroline.7li&legarcfe Barber(ECectronicafTySigned) (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: I— Z Date of Disposition (b 1 b (71 Place of Disposition n'—is 1L— 7_ , W 2 (address) W NCC (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises Al - �-�`M I fY Z 1please print) tL Signature L ai_ Title (067v1472.4 DOH-1555(07/18)p 1 of 2 4,. b ,obi ; it I 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#