Stockman, Steven S
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
r Name First Middle Last Sex(V\
Igi Date of D th Age If Veteran of U.S. Armed Forces,
igt L4acjaoi5 1 _c� War or Dates ` `).&3 85-
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f Circumstances Investigation
119 Medical Certifier Name I Title
0' Address `l a- I
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ux Burial Date I emetery or Crematory
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Date { Place Removed
2 Removal _ i and/or Held
zr and/or Address
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Date - — - feint of
l i Transportation Shipment
6 by Common Destination
Carrier
Date Cemetery Address
0 Disinterment
Date Cemetery Address
:: 0 Reinterment 1
Permit Issued to / ,1Registration Number
Name of Funeral Home I a na rd b: &tAer Fuiieccj Home_ 1 0( ) 30
igi Address /1 Lara.yettc L3t. , bu r ci)S&U J ; 1Ue w L%rIL l a?3Gy
ti' Name of Funeral Firm Making Disposition or to Whom
b Remains are Shipped, If Other than Above
Address
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`PPermission is hereby granted to dispose of the human remains describedAor as indicated.
1«= Date lssuedS I 1 Registrar of Vital Statistics i -Cti C ! )
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"' District Number L9 cr) Place j 0 C
I certify that the remains of the decedent identified above were disposed of in acco nce ith this permit on:
• Date of Dispositionill 4/27/201 5Place of Disposition Pine View Cemetery, Queensbury, NY
(address)
iU New Hudson, 34, Sae_ 3 9
cc cc (section) (lot number) (grave number)
O Name of Se or Person in Charge of Premises Connie L. Goedert
Z (please print)
fil Signature (t-G&s-e. -4 c -,C Title Cemetery Superintendent
(over)
DOH-1555 (9/98)
4AME STOCKMAN, Steven1"\'`ftftlif0)(
ge3j 53
ause: Natural
of Owner: William, Richard Threw, Donald Stockman
ot # 34, Sec. 3, New Hudson
rave # 9
ase # Concrete
)ied: 4/29/2015
terred: 5/4/201 5
ndertaker: Maynard Baker
THREW —6106i<M 44 r ,
William Threw, Richard Threw,&Donald Stockman Lot No. 34
.ddress Luzerne Road, RD#3, Glens Falls, N.Y. Section No. 3
)wner William Threw, Richard Threw & Donald Stockman PlotNew Hudson
7ou,ncla1 0v1
)ate May 9, 1968
400 Superficial ft. @ $1.50 per Sq.Ft.
vocation bounded North, East, South and West by
grass paths. South by lots of
King and Frasier
orner Posts
remarks f /
u it;Q[t`T r'C i:J c'T ./ C l r6l t u/ 4=�f W.' �t� In:_ t" sT�l f' " G-
C792 - 2o62\ �3QP
peed No. (and changes) 11047
ayment Record May 9, 1968 Paid in Full
Il �'
CA 2/
Form No. 01 411 "V
\, d'
Record of Interments
71
1 5
EdWard W. Threw .5--/-r-2.
0a0 'D-alb
2 6
Rosemary W Threw G/111/W1
sx Elizabeth Threw 10/14/03 / I
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rii.,t) ,./ 2
4 WI Threw .5--?-6 P / 8
A
9 — Steven Stockman 5/4/2015
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