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Ure, Daniel Carl NEW YORK STATE DEPARTMENT OF HEALTH "," Burial - Transit Permit Bureau of Vital Records • Name First Middle Last Sex Daniel Carl Ure Male Date of Death Age If Veteran of U.S.Armed Forces, 08/20/2023 64 Years War or Dates F Place of Death Hospital,Institution or WCity,Town or Village Hudson Falls Village Street Address 13 Delaware Avenue,Hudson Falls Village,New York 12828 p Manner of Death Natural Cause ❑Accident Homicide Suicide Undetermined Pending VCircumstances Investigation W Medical Certifier Name Title CI 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 26 Burial Date Cemetery,Crematory or Facility Name 08/23/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held F Hold Address N 0 0. Date Point of t/)❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address - ElReinterment 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 a Address IX W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/23/2023 Registrar of Vital Statistics Cynthia Bard n(ECectronica1Ty 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: Z iW Date of Disposition $/23-I Z3 Place of Disposition (, a (address) W N CC (section) / /latnumber/ (grave number) 0 Name of Sexton or Person in Charge of P mises O L Im z (4se print) W Signature Title [PONT( r:_, 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 bugaL permit Official Funeral Directors Reg.or License#