Cavanagh, John NEW`YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
John A. Cavanagh Male
Date of Death Age If Veteran of U.S. Armed Forces,
July 15,2011 80 War or Dates
iPlace of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death X Natural Cause u Accident Homicide n Suicide n Undetermined Pending
KS Circumstances Investigation
w Medical Certifier Name Title
P Evangelos Pallis MD
Address
Glens Falls,NY
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 376
®Burial Date Cemetery or Crematory
❑Entombment July 21,2011 Pine View Cemetery
Address
El Cremation Quaker Road, Queensbury,NY 12801
Date Place Removed
ZZ U Removal and/or Held
9. and/or Address
Hold
N
0 Date Point of
NE Transportation Shipment
'p by Common Destination
Carrier
pi Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan& Denny Funeral Home 01443
Address
53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
El Address
lit
Permission is hereby granted to dispose of the human remains describe above as ' dice
Date Issued 07�V/ '/ Registrar of Vital Statistics i d�c/
(signature)
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:
Z
WJ Date of Disposition 7/21/11 Place of Disposition Pine View Cemetery
W (address)
to Horicon 27B 1
W (section) (lot number) (grave number)
pName of Sexton or Person in Charge of Premises Michael Genier
Z (please print)
W Signatures' A , Title Superintendent
(over)
DOH-1555(02/2004)