Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Rathbun, Daryl Leon
if . igli NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Daryl Leon Rathbun Male Date of Death Age If Veteran of U:5:Armed Forces, 10/02/2023 86 Years War or Dates Place of Death Hospital,Institution or fi City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation W Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation d Medical Certifier Name Title Courtney Diamond NP Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 455 Burial Date Cemetery,Crematory or Facility Name 10/03/2023 Pineview Crematorium Entombment— Address ©Cremation Queensbury Town,New York ❑Donation 0❑Removal Date Place Removed and/or and/or Held Fr. Hold Address ❑Transportation Date Point of by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Mason Funeral Home 01117 Address 18 George St Po Box 277,Fort Ann,New York 12827-0277 Name of Funeral Firm Making Disposition or to Whom 1..: Remains are Shipped,If Other than Above Address LC. W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/03/2023 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: F'_ Date of Disposition /o/y 123 Place of Disposition TFt� `LIt<0.) l r _ a (address) 01 CC (section) pot number) (grave number) 8 Name of Sexton or Person in Charge f Premises 7-# r. II H" z f(please print) Signature 7 Title lr`' 61.114/1/4 DOH-1555(07/18)pi of 2 _ 1.7 3 3 8 Public Health Law Sec. 4145(2b) Receipt Human remains of "I delivered on , 20" '- Pine View Cemetery ."` Representing the funeral home named op.burial permit Official Funeral Directors Reg.or License# "� r