Barkley, Ryan f # 4,8$
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
: Name First Middle Last Sex
= Ryan William Barkley Male
Date of Death Age If Veteran of U.S. Armed Forces,
e 09/13/2017 33 Years War or Dates
• Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Tel Manner of Death 0 Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ri❑Pending
Circumstances Investigation
Medical Certifier Name Title
gZ Wendy Steinhacker PA
Address
100 Park St,Glens Falls,New York 12801
p Death Certificate Filed District Number Register Number
, City, Town or Village Glens Falls 5601 486
0,4 0 Date Cemetery or Crematory
❑Burial
09/15/2017 Pine View Crematory
•❑Entombment Address
®Cremation Queensbury, New York
M. Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
• ❑Transportation Shipment
by Common Destination
Carrier
14; ❑Disinterment Date Cemetery Address
❑Renterment Date ' Cemetery Address
.,• Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
" Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
e
Address
¢�i
Permission is hereby granted to dispose of the human remains described above as indicated.
;,- Date Issued 09/14/2017 Registrar of Vital Statistics Men ACurtis E4aronicaayAral
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
•, Date of Disposition Place of Disposition fidpil ..) (.,,,Qf ..
(address)
e (section) lot number) (grave number)
Name of Sexton or Person in Charge of P emises ti Ndirt
/ (pie se print)
Signature `� Title /$ r QatL
(over)
DOH-1555 (02/2004)