Webster, John NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
ff Name First Middle Last Sex
ffr John Orlia Webster,Sr. Male
fr Date of Death Age If Veteran of U.S. Armed Forces,
r July 22, 2015 95 War or Dates World War II
Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address 266 Chestnut Ridge ROad
. . Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Gerald F Abess
Address
r 3 Irongate Center
1i Dea to Filed 40-e-v66(1
District Number Register_Number
' � Cit , Town illage (p6 (a�0 Burial Date Cemetery or Crematory
July 27, 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
Cl)
O Date Point of
ej 1 I Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
r;r Permit Issued to Registration Number
: ; Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury, NY 12804
rr Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
r::. Permission is hereby granted to dispose of the human retT�a d‘scr a e s i dicated.
Date Issued .��4-1`� Registrar of Vital Statistics
r.: (signature)
: r District Number SG,51 Place 0 b►Nl Di_efilitItA4
I certify that the remains of the decedent identified abov ere disposed of in accor nce with this permit on:
W Date of Disposition 7/27/201 'lace of Disposition p ne View Cemetery, Queensbury, NY
2 (address)
U Sec. 3, New Hudson 26C 2
(section) (lot number) (grave number)
Q• Name of Sext or Person in Charge of Premises Connie L. Goedert
Z (please print)
W Signature/ it j3pa1 Title Cemetery Superintendent
III���J (over)
DOH-1555(02/2004)
,_ .Webster '
Lot No. 26C
Address RD#1 Chestnut Ridge Road Box 528 Glens Falls. N.Y. 12801 Section No. 3
Owner John 0. & Doris M. Webster Plot New Hudson
,....: .)
Date 7/28/83
4pprox. 100 Superficial ft. @
Location B nded North by bath, South by Colchester, Fast by white West by path
Corner Posts
Remarks
Deed No. (and changes) 1785 Tranferred Prom 1019
Payment Record paid in mill R/R/ 7
Record of Interments
1
---X2 v\i'l n 0. lal�-10 S ct - 7/a7/i c Ps �� co
-DoRi S I.(M-i ' �a-7-aa -� i A /S H
4 FS
5 '" K ; X ,
7-
6l E
II
8 I Co 1 c h es 1--e r /
V/
w ;e E
Form No. 01
5
'JAME Webster, John O.
Age: 95
Cause: Natural
Lot Owner: John O. and Doris M. Webster
Lot # 26C, Sec. 3, New Hudson
Grave # 2
Case # Cement
Died: 7/22/2015
Interred: 7/27/2015
Undertaker: Regan Denny Stafford