Hoyt, Gordon Town of Queensbury
yCertification of Cremation
� � Pine View Cemetery and Crematory
This certifies that the remains of: Gordon Hoyt Sr.
were cremated on December 26 20 18 at the Pine View
(Month) (Day)
Crematorium, Queensbury,New York, and these are the cremated remains of said body.
Date of Death December , 17 20 18 Age 93
(Month) (Day)
Funeral Home Singleton Sullivan Potter Registered No. 1013
(Authorized Signature)
_ it ID 13
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Gordon J.Hoyt Sr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
12/17/2018 93 Years War or Dates 1944-1946
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death Q Natural Cause 0 Accident 0 Homicide Suicide Undetermined ri Pending
Circumstances Investigation
Medical Certifier Name _ Title
Kasandra Frasier PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District number Register Number
City, Town or Village Glens Falls 5601 589
[]Burial
Date Cemetery or Crematory
12/24/2018 Pine View Crematory
(]Entombment Address
®Cremation Queensbury, New York
Date Place Removed
Removal and/or Held
and/or Address
Hold
Date Point of
Q Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
0 Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/18/2018 Registrar of Vital Statistics Roden Curtis(E(ectronicafySigned)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition /, -..a,6_18' Place of Disposition {�1Y1�
y (address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises d C.r ehvy
(please print)
.�� Signature � Title
(over)
DOH-1555(02/2004)
HOYT
Owner
Gordon & Cynthia Hoyt
Address Plot
139 Chestnut Ridge Road Queensbury, NY 12804 Oneida
Phone # Lot #
518-743-1743 1R9-A
Deed # Date
4057 5/30/2018
Cost Foundation Y - N
1200
Location
Bounded to the North by Path, East by Road
South by Vacant, West by Vacant
Remarks � �, . L2‘,r a
Lon- 3 L \ _ \te`5S
Record of Interments
1 6
4
8
4 9
5 10
-Pa -4- c2A
V 8 : �(
A A f3 0
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VccAiJT
HOYT (7LF')
NAME Gordon Hoyt ' Age: 93
Lot Owner: Gordon & Cynthia Hoyt
Lot# Oneida 1 89 A Grave# 2A
Case: Urn
Died: 1 2. 1 7.2 01 8 Interred: 9. 1 .23
Funeral Home: Singleton Sullivan Potter
Cemetery: Pine View