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Goodness, Christopher Micheal # sit NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Christopher Micheal Goodness Male Date of Death Age If Veteran of U.S.Armed Forces, 06/23/2023 12 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Kingsbury Town Street Address 3026 State Route 4, Kingsbury Town, New York 12839 W Manner of Death Undetermined Pendin �Natural Cause Accident �Homicide Suicide � � g Circumstances Investigation W Medical Certifier Name Title CI Kathryn Neubauer MD Address 43 New Scotland Avenue,Albany(NYSDOH),New York 12208 Death Certificate Filed Town Of Kingsbury District Number Register Number City,Town or Village 5762 12 Burial Date Cemetery,Crematory or Facility Name 06/26/2023 Pine View Crematorium Entpmbment Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held N Hold Address 0 0- Date Point of Cl) Transportation p by Common Shipment Carrier Destination 111 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 Remains are Shipped,If Other than Above g Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/26/2023 Registrar of Vital Statistics Cynthia ABardin(ECectronicalTySigned) (signature) District Number 5762 Place Town Of Kingsbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H JlV_ Z Date of Disposition (pI Z? Z3 Place of Disposition `Fh4,VL, 2 (address) W CC (section) / (lot number) (grave number) n g Name of Sexton or Person in Charge o remises �^^^l� lease print W Signature Title DOH-1555(07/18)p 1 of 2 7 ri 8 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 -- 1I Pine View Cemetery Representing the funeral home nam c1 bj` t)permit Official Funeral Directors Reg.or License#