Ettinger, Henry x
i NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Henry Wands Ettinger Male
Date of Death Age If Veteran of U.S. Armed Forces,
7/12/2018 88 War or Dates Korean
F. Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address 111 Grant Ave
W Manner of Death E Natural Cause �X Accident E Homicide 0 Suicide 0 Undetermined El Pending
Circumstances Investigation
W Medical Certifier Name Title
O Timothy Murphy,Coroner
Address
Haviland Rd,Glens Falls,NY 12801
Death Certificate Filed District Number 601 Register Number 3L17
City, Town or Village
®Burial Date Cemetery or Crematory
July 17,2018 Pine View Cemetery
Address
0 Cremation Quaker Road,Queensbury,NY 12804
Date Place Removed
ZZ Removal and/or Held
and/or Address
F' Hold
N
O Date Point of
N n Transportation Shipment
p by Common Destination
Carrier
n Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
I- Remains are Shipped, If Other than Above
M, Address
W'
a`' Permission is hereby granted to dispose of the human remains descri a ove in .
Date Issued G�?/Co/Zt7/t Registrar of Vital Statistics r
/ (signature)
District Number 560/ Place j ,,,, /Z//S Ay •
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w• Date of Disposition 7/1 7/201 8 Place of Dispositior Pine View Cemetery Queensbury
2 (address)
Mohican #84-H
(section) (lot number) (grave number)
pName of Se ton or Person in Charge of Premises ("ruin I e Goedert
`Z f / (please print)
‘C (y-C_
Signature/ f Title Cemetery Superintendent
(over)
DOH-1555(02/2004)