Jones, Raymond Joseph '17DLF /t 60
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Raymond Joseph Jones Male
Date of Death Age If Veteran of U.S.Armed Forces,
08/20/2023 60 Years War or Dates
1_ Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
Ili
0 Manner of Death []Natural Cause []Accident [Homicide []Suicide []Undetermined []Pending
W I I 'Circumstances I 'Investigation
W Medical Certifier Name Title
LI Mathew Varughese DO
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 390
[]Burial Date I Cemetery,Crematory or Facility Name
08/22/2023 I Pine View Crematory
[]Entombment Address
[]Cremation Queensbury Town,New York
Donation
Z Removal Date Place Removed
and/or and/or Held
i Hold Address
N
0
CL Date Point of
N[]Transportation
p by Common Shipment
Carrier Destination
[]Disinterment
Date Cemetery Address
El
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077
Address
123 Main St,Argyle,New York 12809
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/21/2023 Registrar of Vital Statistics Megan Noln(EYectronicallySiynea9
(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:
F—
Z Date of Disposition gl j))jj Place of Disposition F4, ..;'t_.
111
2 (address)
W
N (section) (lot number) ...s.4t (grave number)
CC ll
a Name of Sexton or Person in Charge of Premises AIL,
�'Q
Z (p! e print)
IL Signature Title � �WI
DOH-1555(07/18)p 1 of 2 ((��
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#