Pansy, Richard NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Richard Pansy I Male
Date of Death Age If Veteran of U.S.Armed Forces,
05/01/2020 69 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Cortlandt Town Street Address New York-Presbyterian-Hudson Valley Hospital
W Manner of Death Undetermined Pending
0 x Natural Cause Accident Homicide Suicide g
W Circumstances Investigation
U
W Medical Certifier Name Title
113 Danny Muskardin MD
Address
1980 Crompond Rd,Cortlandt Town,New York 10567
Death Certificate Filed District Number Register Number
City,Town or Village Cortlandt Town 5951 321
Burial Date Cemetery,Crematory or Facility Name
05/06/2020 Pine View Cemetery and Crematorium
Entombment Address
Cremation Queensbury,New York
Donation
ZO Removal Date Place Removed
and/or and/or Held
F-Cl) Hold Address
O
d Date Point of
NElTransportation
p by Common Shipment
Carrier Destination
❑Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Clark Funeral Home Inc 00340
Address
2104 Sawmill River Rd,Yorktown Heights,New York 10598
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Otherthan Above
Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/04/2020 Registrar of Vital Statistics Laroue!�,Slratzftn(ElectrnnicaY Signed)
(signature)
District Number 5951 Place Cortlandt Town, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition S-� 20 29 Place of Disposition I 1 t"Z Y I���y,, 7JCeG� W.A tau (Q�U91tA
W
2 (address)
W
CO)
(section) OotnumberJ j (grave number/
Name of Sexton or Per har a of Premises J V e r*1 a e,
(please print/Z
W Signature Title r9 c rV 0 Ve
DOH-1555(07/18)p of 2
Public Health Law Sec. 4145(2b)
2 ,.s
Receipt
Human remains of - delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#