Kanner, Charles NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Charles Kanner Male
Date of Death Age If Veteran of U.S.Armed Forces,
May 8,2006 87 War or Dates WWII
Place of Death Hospital, Institution or
ZCity,Town or Village Town of Queensbury Street Address Stanton Nursing and Rehabilitation Centre
IUManner of Death X Natural Cause ❑ Accident ❑ Homicide ❑ Suicide El Undetermined ❑ Pending
Circumstances Investigation
O Medical Certifier Name Title
W Roslyn Socolof MD
Address
152 Sherman Avenue Queensbury,NY 12804
Death Certificate Filed District Number Register Nujn r
City,Town or Village Queensbury 5657
❑ Burial Date Cemetery or Crematory
5/9/2006 Pine View Crematorium
❑ Entombment Address
t=! Cremation Queensbury,NY
Date Place Removed
z ❑ Removal I and/or Held
O and/or Address
Hold
Date Point of
n.• ❑ Transportation Shipment
by Common Destination
Carrier
Date Cemetery Address
f l Disinterment
Date Cemetery Address
❑ Renterment
Permit Issued to I Registration Number
Name of Funeral Home Regan&Denny Funeral Home
Address
53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
t„^ Remains are Shipped, If Other than Above
- Address
aPermission is hereby granted to dispose of the human Tema' described above as" dicated.
Date Issued 5- 9-d-t,c,b Registrar of Vital Statistics
signature)
District Number 5657 Place Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 5 /I l hi Place of Disposition (c z r..,;,f r', a,.,
(address)
✓ (section) ii (lot number) (grave number)
O Name of Sexton or Person in Charge of Premises ( h r �:5 5y n hatr
CI CI �, cc,, (please print)
W Signature C Al�.sv^4' Title it 6�.�+11 r
DOH-1555 (02/2004) (over)