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Stearns, Peter Rynders NEW YORKSTATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Peter Rynders Steams Male Date of Death Age If Veteran of U.S.Armed Forces, 08/09/2023 83 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Hudson Falls Village Street Address 106 Main Street, Hudson Falls Village, New York 12828 'p Manner of Death Natural Cause Accident Homicide Suicide Undetermined ri Pending Circumstances Investigation WMedical Certifier Name Title 0 Robert Lemieux Coroner Address 415 Lower Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed Village Of Hudson Falls District Number Register Number City,Town or Village 5726 22 Burial Date Cemetery,Crematory or Facility Name 08/11/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held Hold Address N 0 d Date Point of U) Transportation Q by Common Shipment Carrier Destination Date Cemetery Address Disinterment 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 ▪ Address CC O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/11/2023 Registrar of Vital Statistics Cynthia Bardin(ECectronicaCCy Signed) (signature) District Number 5726 Place Village Of Hudson Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition P-/2-2O23 Place of Disposition /�✓1e U I-wJ 2 (address) W N (section) /(lot number) (grave number) O Name of Sexton or Pe on in C arge of Premises �""�'GN �w� CAv e (please print)W 6lE /��/ Title �d d�ci a"- Signature m ~ DOH-1555(07/18)p 1 of 2