Krantz, Howard c l
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
<: Name First Howard Middle Ian Last Krantz Sex
male
Date of Death Age If Veteran of U.S. Armed Forces,
November 21 , 2015 69 War or Dates NA
iiio Place of Death Hospital, Institution or
:Z City, Town or Village Glens Falls, NY Street Address Glens Falls Hospital
1 Manner of Death®Natural Cause 0 Accident 0 Homicide El Suicide Undetermined r7 Pending
Circumstances Investigation
hil Medical Certifier Name Title
CIEric Pillemerffi NID
Address
Glens Falls Hospital, Glens Falls, NY
Death Certificate FiledGlens Falls, NY District Number 5 uo' Register 1. be
City, Town or Village
���L)
Date Cemeter or Crema r
Burial November 24, 2015 Pile View ematory •
Address
❑Cremation Queensbury, NY
Date I Place Removed
0 ❑Removal and/or Held
and/or Address
ra Hold
0 Date Point of
NQ Transportation , Shipment
a by Common Destination
Carrier
0
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
` Name of Funeral Home Regan Denny Stafford Funeral Home 01443
< • Address
;»y 53 Quaker Rd. Queensbury, NY 12804
'' 'j Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
'm Address
M
<'i: Permission is hereb granted to dispose of the human remns descr'bed above s indicated
ik
Date Issued /1 cC.,&K Registrar of Vital Statistics • p Q 77 /
_ (signa r _
`'i, District Number�"/p l ��j Place �_-- >7
I certify that the remains of the decedent identified above were disposed of in accordance with this rmit on:
f-
WDate of Disposition 1 1 /24/1 5 Place of Disposition pine View Cemetery, Queenshury, NY
W (address)
Erie 40B 3
0 CC (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises Connie L. Goedert
F (please print)
W Signature Title Cemetery Superintendent
(over)
DOH-1555 (9/98)