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Doty, Charles Hubert 710 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Charles Hubert Doty Male Date of Death Age If Veteran of U.S.Armed Forces, 02/28/2024 64 Years War or Dates t,. Place of Death Hospital,Institution or Z City,Town or Village Kingsbury Town Street Address 111 Dean Road, Kingsbury Town, New York 12809 UJ 'p Manner of Death Ei Natural Cause Accident ❑Homicide IllSuicide FlUndetermined ri Pending ✓ Circumstances Investigation WD Medical Certifier Name Title William Parker MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Kingsbury District Number Register Number City,Town or Village 5762 7 Burial Date Cemetery,Crematory or Facility Name 03/01/2024 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation ❑Removal Date Place Removed and/or and/or Held H Hold Address CO 0 a Date Point of co ElTransportation 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 N Address CC O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/29/2024 Registrar of Vital Statistics Cynthia Bardin(ECectronica1 y Signed) (signature) District Number 5762 Place Town Of Kingsbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 2.,2ca s/ Place of Disposition :v l �t ,, �.i��riti t`r� 2 /address/► W CC (section) (lot umbel) (grave number) SName of Sexton or Person in Charge of P emise / 1C plyrJV ✓ 1 V(OA Z (please print) W Title vt Signature J 374 C 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#