Punda, Donald NEW YORK STATE DEPARTMENT OF HEALTH
' Vital Records Section Burial - Transit Permit
Miii Name First Middle Last Sex
Donald Punda male
[ Date of Death 04/11/2006 Age 76 If Veteran of U.S. Armed Forces,
WiiWar or Dates n/a
154 Place of Death Hospital, Institution or
i , Townjile Queensbur Street Address Westmount Health Facility
i Manner of Death E Natural Cause ii Accident Homicide Suicide Undetermined 0 Pending
lilt Circumstances Investigation
tu Medical Certifier Name Title
Roslyn Socolof, MD
Address
42 'Gurney Lane, Queensbury, NY 12804
gii Death Certificate Filed ' District Number Reg. ter,Number
elf k, TownXIMMUCAX Queensbury 5657
iimBurial Date Cemetery or Crematory
04/14/2006 Pine Vlew Cemetery
QEntombment Address
iiiiiii 0 Cremation Queensbur , NY 12804
Date Place Removed
Z Removal and/or Held
2[—I
and/or
I; Address
Hold
fa
0 Date Point of
N❑Transportation Shipment
0 by Common Destination
Carrier
Date I Cemetery Address
El Disinterment
Reinterment Date Cemetery Address f
Permit Issued to < Registration Number
Name of Funeral HomeRegan & Denny Funeral Home 01 519
Address 53 Quaker Road,
Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
I_ Remains are Shipped, If Other than Above
2 Address
CC
‘3` Permission is hereby granted to dispose of the huma emains described above as indicated.
Date Issued 1 i��f a5(Oiegistrar of Vital Statistics 1CC ,r OGL>
(signature)
District Numbe Place / Cs, r_) (--L91Q�1,
I certify that the remains of the decedent identified above wer disposed of in accordan wit this permit on:
2
w Date of Disposition 4/14/06 Place of Disposition P1 NE VIEW CEME EERY.QUFFNSRIIRY NV
(address)
tii
ta FREIE GRouND #4 3
re (section) (lot number) (grave number)
a
Name of Sexton or Person in Charge of Premises ivl1'"HAFL GEN I ER
(please print)
Signatur / Title SUnr.
(over)
DOH-1555 (02/2004)