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Henry, Paul Eric
'OLF tf 2 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Paul Eric Henry Male Date of Death Age If Veteran of U.S.Armed Forces, 03/09/2024 89 Years War or Dates 1955-1957 Place of Death Hospital,Institution or Z City,Town or Village Fort Ann Town Street Address 280 Whitney Road, Fort Ann Town, New York 12827 p Manner of Death Z Natural Cause EAccident 1:1Homicide DSuicide Undetermined ri Pending W Circumstances Investigation t j Medical Certifier Name Title p Kenneth France MD Address 9 Carey Road,Queensbury Town, New York 12804 Death Certificate Filed Town Of Fort Ann District Number Register Number City,Town or Village 5754 5 Burial Date Cemetery,Crematory or Facility Name 03/12/2024 Pine View Crematory _Entombment Address ©Cremation Queensbury Town,New York Donation Z❑Removal Date Place Removed and/or and/or Held N Hold Address 0 n. Date Point of U) Transportation Shipment p by Common Carrier Destination E Date Cemetery Address Disinterment O Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 1. Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/11/2024 Registrar of Vital Statistics Miranda Jferringskaw(ECectronica1Ty Signed) (signature) District Number 5754 Place Town Of Fort Ann I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition 3 I 12129 Place of Disposition Fr ,r,,,) 2 (address) ILI NCC (section) (lot number) (grave number) � ::::: °° or Person in CharP .ses Title DOH-1555(07/18)p 1 of 2 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#