Denton, David a -
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
David A. Denton Male
Date of Death Age If Veteran of U.S.Armed Forces,
September 16,2006 70 War or Dates Korean
Place of Death Cityof Glens Falls Hospital, Institution or
z City,Town or Village Street Address Glens Falls Hospital
WW Manner of Death X Natural Cause ❑ Accident ❑ Homicide El Suicide ElUndetermined ElPending
W Circumstances Investigation
V Medical Certifier Name Title
W Joseph Mihindu,MD
Address
Glens Falls,NY
Death Certificate Filed District Number Register Number
City,Town or Village City of Glens Falls 5601 -15
Burial Date Cemetery or Crematory
Sept 19,2006 Pine View Cemetery
❑ Entombment Address
❑ Cremation Queensbury,NY
Date Place Removed
0 0 Removal and/or Held
and/or Address
F. Hold
N4N Date Point of
❑ Transportation Shipment
( by Common Destination
G Carrier
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
Name of Funeral Home Regan&Denny Funeral Home 01519
Address
53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
i_ Remains are Shipped, If Other than Above
g Address
E
aPermission is hereby granted to dispose of the human remains descri v"di
Date Issued '1 J/9)() 6 Registrar of Vital Statistics
(signature)
District Number 5601 Place City of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
`Z Date of Disposition 9/19/06 Place of Disposition PINE VIEW CEMETERY,QUEENSBURY NY
LI (address)
W [JNAD I LLA EXT, 3-B 2
U) (section) (lot number) (grave number)
O0 Name of Sexton or Person in Charge of Premises M I C HAF l G F N T F R
Z (please print)
W Signature 9jJJk.. Title S U PT.
DOH-1555 (02/2004) (over)