Dwyer, Henry NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Henry C. Dwyer Sr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
September 17,2006 85 War or Dates
I.. City of Death City of Glens Falls Hospital, Institution or Glens Falls Hospital
z City,Town or Village , Street Address
WG Manner of Death El Natural Cause El Accident El Homicide ❑ Suicide ❑ Undetermined El Pending
Circumstances Investigation
U Medical Certifier Name Title
W b - 14-rJ e,L (,v A j
0
Address nn �,1 i�
-II 0062 1�-✓-- /c_.4141...H-1 C2 ��f 1Gla It--,/ (& 5 3
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls _5601 Li h 2
❑ Burial Date Cemetery or Crematory
9/20/2006 Pine View Cremation
❑ Entombment Address
® Cremation Queensbury,NY
Date Place Removed
z ❑ Removal and/or Held
O and/or Address
F= Hold
N Date Point of
d ❑ Transportation Shipment
to 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 4 l 6(9
Address
53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
I•- Remains are Shipped, If Other than Above
Address
IX
1.11
0. Permission is hereby granted to dispose of the human remains descri a vg as i i .(4.A..)
Date Issued 1 11.cal f)6 Registrar of Vital Statistics
(signa ure)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
al
Date of Disposition ci/;li/6 L. Place of Disposition Pink ,��(� C rr-•4t or) -,-...
al (address)
W
(section) (lot number) (grave number)
Ce
O Name of Sexton or Person in Charge of Premises L r + s Stvir+-t tot-
CI (please print)
W• Signature Ate- Title Ct7-,•"AA-C r
DOH-1555 (02/2004) (over)