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Gray, Larry George 11:19 it 1,-) NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Per it Bureau of Vital Records Name First Middle Last Sex Larry George Gray Male Date of Death Age If Veteran of U.S.Armed Forces, 01/12/2024 82 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare UJ Ip Manner of Death a Natural Cause Accident HomicideI:I Suicide ❑Undetermined n Pending UCircumstances Investigation ILI Medical Certifier Name Title G Deborah Norris NP Address 4573 State Route 40,Argyle Town,New York 12809 Death Certificate Filed Town Of Argyle District Number Register Number City,Town or Village 5750 7 Burial Date Cemetery,Crematory or Facility Name 01/18/2024 Pine View Crematorium _Entombment Address ©Cremation Queensbury Town,New York Donation ❑Removal Date Place Removed and/or and/or Held - Hold Address N 0 0• Date Point of U/1, Transportation by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom F- 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 01/17/2024 Registrar of Vital Statistics Shef(ey Mckernon(ECectronicafty Signed) (signature) District Number 5750 Place Town Of Argyle I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition I i litiry Place of Disposition F7 ;A—J jr n41`1e W 2 (address) W CC (section) (lot number) (grave number) Name of Sexton or Person in Charge of Px es tt ✓/ (please print) IL Signature Title DOH-1555(07/18)p 1 of 2 ) ., 7 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#