Danahy, Richard Town of Queensbury
"Oki Certification of Cremation
Pine View Cemetery and Crematory
This certifies that the remains of: Richard Danahy
were cremated on September , 25 20 17 at the Pine View
(Month) (Day)
Crematorium, Queensbury, New York, and these are the cremated remains of said body.
Date of Death September 18 20 17 Age 66
(Month) (Day)
Funeral Home Carleton Registered No. 712
ii2
(Authorized Signature)
NEW YORK STATE DEPARTMENT OF HEALTH 71 2:
Vital Records Section
Burial - Transit Permit
Name First Middle Last Sex
Richard Joseph Danahy Sr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
September 18, 2017 66 War or Dates
Pr Place of Death Hospital, Institution or
City, Town or Village Hudson Falls Street Address 136 John Street
W Manner of Death Xj Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined El❑ Pending
Circumstances Investigation
W Medical Certifier Name Title
John Stoutenberg MD, M.D. Dr.
Address
102 Park St. Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village
❑Burial Date Cemetery or Crematory
September 21, 2017 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
• and/or Address
Hold
Date Point of
a. ❑Transportation Shipment
co by Common Destination
1f Carrier
❑ Disinterment Date Cemetery Address
❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
I- Remains are Shipped, If Other than Above
• Address
lx
w
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued r/4)l/ /7 Registrar of Vital Statistics tg -r
(signature)
District Number 5 7 lc Place 1 //4e. G ( NiAch`n fG IIS
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition 09/21/2017 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
ILI
(section) (lot number) (' (grave number)
a` Name of Sexton or Person in Charge of remises �ru`� ✓ ^���
(pl se print)
W feE 1hP1 Signature Title
(over)
DOH-1555 (02/2004)