Cooke, Kenneth NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
11111 Name First Middle Last Sex
Kenneth D. Cooke Male
Date of Death Age If Veteran of U.S. Armed Fon000,
June 30, 2017 93 War or Dates NA
Place ofDeath Hospital, Institution or
Cih/. Town or Village Glens Falls
Manner GlensFallsHospital
Monnerof Death Natural ��auom Accident Homicide ��Suicid� Undetermined �-lPending
— ' ' Circumstances ' 'Investigation
W1edioo| Certifier Name Tide
�0Ac|' �L/�
Address
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Death Certificate Filed District Numb Regis
City, Town or Village Glens Falls, NY
El Burial Date Cemetery or Crematory ' `~
[�En��bn�n July 3, 2017 Pine View Crematorium
^
Address
Cremation 5D Quaker Road, Qumenmbury, NY82804
Date Place Removed
Removal and/or Held
and/or
Address
Hold
Data Point of
FlTronopodaUon Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
F-lRainUennent Oahe Cemetery Address
Permit Issued to Registration Number
Nomo of Funeral Home Regan Denny Stafford Funeral Home 08443
Addraon
53 Quaker Road, Qumenmbury, NY 12804
Name of Funeral Firm Making Disposition ortoWhom
Remains are Shipped. |f Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
��f ' /
Ooho Issued '7 " _~ ���� �'� Registrar ofVital Statisticsc'`~
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x�
(signature) "j
District Number C� ) p|a�� �� � *� A/ ` J
'_ -�� ~. ., .
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Uj Date ofDisposition 7/ 5//l Place of Disposition �U�� r~.~
(address)
UJI
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of P eo ���
�� (lease p^'"
Signature /'� �� Title Npd�D@
(over)
OOH-1555(03/2004)