Creeden, Daniel b NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Daniel Mark Creeden Male
▪ :: Date of Death Age If Veteran of U.S. Armed Forces,
September 28, 2015 55 War or Dates
iPlace of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death n Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
gi Michael Miles,MD
rr Address
r f 100 Park Street,Glens Falls,NY
;% : Death Certificate Filed District Number Register N4mber
:::- City, Town or Village .560
Ex Burial Date Cemetery or Crematory
September 30,2015 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
co
O Date Point of
O.
Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
:::: Permit Issued to Registration Number
:;: Name of Funeral Home Regan& Denny Funeral Home 01444
• Address
94 Saratoga Avenue, South Glens Falls,NY 12803
::: Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
:::; Permission is hereby granted to dispose of the human emain describe above •s indi ated.
▪ Date Issued 3cJ __. Registrar of Vital Statistics '.'27 I #
(signature)
District Number ,�Sza,0 / Place 2_.7,44 it---ee;�� >7 6
I certify that the remains of the decedent identified above were disposed of in accord ce with this permit on:
Z
w Date of Disposition 9/30/1 5 Place of Disposition Pine View Cemetery, Queensbury, NY
2 (address)
cocm
Hudson #1 19C 1
O (section) (lot number) (grave number)
pName of Sexton or Person in Charge of Pre ises Connie L. Goedert
Z 4 (please print)
ILSignature lGeikka.. k 72CL4 Title Cemetery Superintendent
(over)
DOH-1555(02/2004)