Riley, Hugh James NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Hugh James Riley Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/11/2023 72 Years War or Dates
• Place of Death Hospital,Institution or
W City,Town or Village Queensbury Town Street Address 570 Moonhill Road, Queensbury Town, New York 12804
`p Manner of Death Natural Cause Accident Homicide Suicide FlUndetermined ❑Pending
I—IU Circumstances Investigation
WCJ Medical Certifier Name Title
Scott Miller PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 112
Burial Date Cemetery,Crematory or Facility Name
•n= 07/14/2023 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
❑Donation
❑Removal Date Place Removed
and/or and/or Held
H Hold Address
(t)
0
G. Date Point of
(b') Transportation
p by Common Shipment
Carrier Destination
ElDisinterment Date Cemetery Address
Reinterment late 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
Address
CC
W—
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/14/2023 Registrar of Vital Statistics Caroline 7-fildegardeBar6er(Electronically Signed)
(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:
H
z Date of Disposition 7/S 3 Place of Disposition
W ffL ',.JP Vie,r7 L'.re—ma
(address)
W
N (section) (lot number) (grave number)
• Name of Sexton or Person in Charge of Premises } 19�rIp"✓b t‘20(T1
Z (please print)
tL Signature �- ` Title p l� a r
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) `M `'
Receipt
Human remains of delivered on , 20 <'
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License# `' '