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Martin, Francis A
......, . 103 4113) NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital.Records Name First Middle Last Sex Francis A Martin Male Date of Death Age If Veteran of U.S.Armed Forces, 08/30/2023 83 Years War or Dates 1.., Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital Ili p Manner of Death El Natural Cause ❑ Homicide Suicide Accident ❑Undetermined ❑Pending UJ 0 Circumstances Investigation UJ Medical Certifier Name Title CI Christopher Smith MD 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 408 Burial Date Cemetery,Crematory or Facility Name ...' 09/02/2023 Pineview Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation 0 El Removal Date Place Removed and/or and/or Held N Hold Address 0 a Date Point of N❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom 1... Remains are Shipped,If Other than Above Address CC W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/01/2023 Registrar of Vital Statistics Megan Nolin(Electronically Signed) (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: H Z Date of Disposition II T 17 Place of Disposition FS__ /-51---.., UJ 2 (a W CO CC (section) itt number) si,., (grave number) 8Name of Sexton or Person in Charge of ' ^ es tri z (Pleas riot) Signature Title f6C/f `L DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 i , , Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#