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Dumont, George Henry ,LF-- itstp2 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex George Henry Dumont Male Date of Death Age If Veteran of U.S.Armed Forces, 07/07/2023 70 Years War or Dates I— Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital 13 Manner of Death ❑^ Natural Cause Accident Homicide OSuicide ❑Undetermined riPending W Circumstances Investigation W Medical Certifier Name Title G Bo Li MD Address 100 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 336 Burial Date Cemetery,Crematory or Facility Name 07/11/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held F- Hold Address U) 0 C. Date Point of U) Transportation p by Common Shipment Carrier Destination 111 Disinterment Date Cemetery Address EI 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 H Remains are Shipped,If Other than Above s Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/11/2023 Registrar of Vital Statistics Megan Wolin(ECectronicaCCySigned) (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: IH � Z Date of Disposition �71 a113 Place of Disposition I �U--. 49,------ iu 2 (address) W N (section) (lot number) (grave number) °` ti O Name of Sexton or Person in Charge o remises nt V Z (plea print) LEI Signature Title �� l"' DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) .` Receipt Human remains of t < delivered on , 20 4- Pine View Cemetery Representing the funeral home named!on burial rmit Official Funeral Directors Reg.or License#