Peattie, Joseph 4i
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Per it
Name First Middle Last Sex
Joseph
Peattie
...... Male
Date of Death Age If Veteran of U.S. Armed Forces,
01/01/2020
War or Dates _
Place of Death Hospital, Institution or
RkxTown or \Al*ltnnStreet Address
3 Ryan Rd
Manner of Death®'Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Medical Certifier Name Title Circumstances Investigation
Address
161 Carey Rd Queesnbury, N Y 12804
Death Certificate Filed District Number Register Number
fiNUTown or
❑Burial Date Cemetery or Crematory
❑Entombment Address
Cremation Queensbury. New York
Date Place Removed
❑Removal and/or Held
and/or Address
�= Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
f........❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan & DennyFuneral Home 01443
Address
53 Quaker Rd. ueensbu ny 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described a ove as indicated.
Date Issued 01/03/2020 Registrar of Vital Statistics
s gnat )
District Number 45RA Place Wilton
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition Place of Disposition 'P1�Jc° �� / epc'mk
(a dress)
(section) lot n tuber) (grave number)
Name of Sexton or P rson in arge of Premises 2AVty'3. d
�+ (please print)
Signature S Title eft"
(over)
DOH-1555 (02/2004)
Public Health Law Sec. 4145(2b) 01 3 2 0
Receipt
Human remains of delivered on , 20fi(i kj
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#