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Florence, Paul Henry - ' 1:-(71 tt 1 „--) NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Paul Henry Florence Male Date of Death Age If Veteran of U.S.Armed Forces, 02/02/2024 90 Years War or Dates 1950-1954 l— Place of Death Hospital,Institution or W City,Town or Village Hudson Falls Village Street Address 22 Feeder Street, Hudson Falls Village,New York 12839 pManner of Death Ei Natural Cause Accident 0 Homicide Suicide nUndetermined nPending C.) fI I(Circumstances II ''Investigation WW Medical Certifier Name Title Emily Goodrich NP Address 3 Irongate Center Center,Glens Falls,New York 12801 Death Certificate Filed Village Of Hudson Falls District Number Register Number City,Town or Village 5726 7 Burial Date Cemetery,Crematory or Facility Name 02/05/2024 Pine View Crematorium Entombment — Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held F- Hold Address U) 0 d Date Point of U)❑Transportation p 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 IH Remains are Shipped,If Other than Above M Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/02/2024 Registrar of Vital Statistics Cynthia (Bardin(E(ectronica((ySigned) (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: IF— Z 2.Date of Disposition l 7lZ tt Place of Disposition 'W f t,u� MA 70(?,T- . (ac(ires I W N Cr (section) d (lot number) (grave number) OName of Sexton or Person in Charge of Premises V Z ' se print/ lw ( i7rig Signature Title DOH-1555(o7/18)p t of 2 :;I 7ci r 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#