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Rounds, Eugene Burton
t 4'$3 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Eugene Burton Rounds Male Date of Death Age If Veteran of U.S.Armed Forces, 10/08/2023 84 Years War or Dates 1957-1959 F— Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital 'p Manner of Deatlic. Z Natural Cause ❑Accident Homicide Suicide Undetermined Pending VCircumstances Investigation E Medical Certifier Name Title Gwendolyn Moms-Dickinson PA 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 469 Burial Date Cemetery,Crematory or Facility Name 10/10/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York . Donation OZ❑Removal Date Place Removed and/or and/or Held F—N Hold Address 0 0. Date Point of t/)❑Transportation ES by Common Shipment Carrier Destination Date Cemetery Address nDisinterment Date Cemetery Address I I Reinterment Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom E.. Remains are Shipped,If Other than Above a Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/10/2023 Registrar of Vital Statistics Megan Noli'n(ECectronica1TySigned) (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 b/ii 113 Place of Disposition ' I✓F✓ Cp6'ai4'�'oRTi✓� W 2 (address) W CC (section) +flotnum eri (grave number) g Name of Sexton or Person in Charge of Premises Aev.‘eti lease print) Z `` W Signature Title ` "F'rn DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt T' Human remains of. fi • ,.. , ; , �' � %- delivered on , • Pine View Cemetery Representing the funeral home named on burial,,permit Official Funeral Directors Reg. or License#, er-