Calby, Paul ANEW'"`{ORK STATE DEPARTMENT OF HEALTH Bu
rial Records Section - Transit Permit
Name First Middle Last Sex
Paul V. Calby Male
Date of Death Age If Veteran of U.S. Armed Forces,
March 22, 2012 45 War or Dates
Place of Death Hospital, Institution or
Z. City, Town or Village Queensbury Street Address 7 Shallow Creek
W.
al Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
t Circumstances Investigation
;u Medical Certifier Name Title
P. John P. Stoutenburg MD
Address
102 Park Street,Glens Falls,NY 12801
:- Death Certificate Filed District Number Register Number
.: City, Town or Village Queensbury 5657
❑X Burial Date Cemetery or Crematory
March 26, 2012 Pine View Cemetery
❑Entombment Address
III Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z I I Removal I and/or Held
and/or Address
H Hold
N
O Date Point of
co Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
I I Reinterment
Date ! Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Home I 01443
Address
53 Quaker Road, Queensbury, NY 12804
1,:w: Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped, If Other than Above
g Address
41
Permission is hereby granted to dispose of the human rema's`described above as i i ated.
Date Issued 3 03 a-e,)t Registrar of Vital Statistics i
r•
(signature)
District Number 5657 Place Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 3/26/1 2 Place of Disposition Pine View Cemetery
2 (address)
W
N Erie 17F 1
II (section) (lot number) (grave number)
Q Name of Sexton or Perso in Charge of Premises Michael Genier
Z _ _ (please print)
Signature \J./PA-L.4/N; Title Superintendent
(over)
DOH-1555(02/2004)