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Alden, Jeffery Scott Jr. NEW YORK STATE DEPARTMENT OF HEALTH - ' Bureauof Vital Records BurialTransit Permit la e Name First Middle Last Sex Jeffery Scott Alden Jr Male Date of Death Age If Veteran of U.S.Armed Forces, 12/27/2023 44 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Hudson Falls Village Street Address 1 Third Avenue, Hudson Falls Village, New York 12839 'p Manner of Death Natural Cause Accident Homicide Suicide Undetermined ri Pending Circumstances Investigation W Medical Certifier Name Title G Frances Bollinger MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed Village Of Hudson Falls District Number Register Number City,Town or Village 5726 Burial Date Cemetery,Crematory or Facility Name 01/02/2024 Pine View Crematory Entombment Address ©Cremation Queensbury,New York Donation 8❑Removal Date Place Removed and/or and/or Held ~ N Hold Address 0 a Date Point of (I)❑Transportation by Common Shipment Carrier Destination ODisinterment Date Cemetery Address 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 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/02/2024 Registrar of Vital Statistics Cynthia Bardin(ElectronicaltySigned) (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 W Date of Disposition I j 3j7q Place of Disposition TMEvv4,0 (address) (I) CC (section) / (lotnpmber/ (grave number) 8 Name of Sexton or Person in Charge of Premises `'' •. L • Z (phase print) W Signature Title frf 1t DOH-1555(07/18)p 1 of 2 `J j Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#