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Carlton, Christopher Wayne A zs-i . ., LF NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Christopher Wayne Carlton Male Date of Death Age If Veteran of U.S.Armed Forces, 03/11/2024 49 Years War or Dates (` Place of Death Hospital.Institution or WCity,Town or Village Corinth Town Street Address 603 Main Street,Corinth Town, New York 12822 p• Manner of Death Natural Cause Accident ❑Homicide Suicide Undetermined n Pending Circumstances I !Investigation W• Medical Certifier Name Title O David DeCelle Coroner Address 40 McMaster Street,Ballston Spa,New York 12020 Death Certificate Filed Town Of Corinth District Number Register Number City,Town or Village 4553 14 RBurial Date Cemetery,Crematory or Facility Name 03/13/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York ▪Donation 0❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 O. Date Point of (/)OTransportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address 0 Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom 1.- Remains are Shipped,If Other than Above " Address C W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/13/2024 Registrar of Vital Statistics Brenda L Peris(Electronically Signed) (signature) District Number 4553 Place Town Of Corinth I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— WDate of Disposition 3j)L 119 Place of Disposition I -P/Edr� G04al4 twr 2 (address) W N Crl//(section/ �j(lot number/ (grave number) gName of Sexton or Person in Charge pf remises -7 ^' l ft z (ple a print) /� IJJ Signature Title ! in . •„..Z DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 Receipt Human remains of ` ` delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#