Loading...
Bozak, Gregory Martin t fog NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last 7SexGregory Martin Bozak Date of Death Age If Veteran of U.S.Armed Forces, 12/04/2019 61 Years War or Dates L~ Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W Ip Mannerof Death © Natural Cause Accident Homicide Suicide Undetermined Pending U Circumstances Investigation WW Medical Certifier Name Title Marcille Labban MD Address 100 Park St,Glens Falls, New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 524 ❑Burial Date , Cemetery,Crematory or Facility Name 12/06/2019 Pine View Crematory Entombment Address MV IX 1 Cremation Queensbury Town, New York Donation 0 Removal Date Place Removed and/or and/or Held H N Hold Address O IL Date Point of (1) FiTransportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Miller Funeral Home 01199 Address 6357 Nys Fite#30, Indian Lake, New York 12842 Name of Funeral Firm Making Disposition or to Whom Ih Remains are Shipped,If Other than Above 2 Address IX W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/06/2019 Registrar of Vital Statistics Ra5»1AntiwCLrtis(E16drerid1y9gW (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H z Date of Disposition 1716115 Place of Disposition P�'4U,..' W 2 (address) W N (section) (lot number) (grave number) 3 GName of Sexton or Person in Charge of Premises tL' L '"'�� Z (ple se print) W Signature d �a— Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) .31.3 3 Receipt Human remains of delivered on , 20_ Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#