Meade, DavidNEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
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David Matthew Meade $ex
Date of Death Male
Age If Veteran of US. Armed Forces,
10/24/2019 54 Years War or Oates Navy
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Place of Death Hospital, Institution or
City, Town or Village
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Glens Falls Street Address 18 Staple Street, Glens Falls, New York 12801
Manner of Death Natural Cause Accident
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Homicide Suicide Undetermined Pending
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Circumstances
Medical Certifier Name Investigation
ID
Title
Timothy Murphy Coroner
Address
52 Haviland Avenue, Glens Falls, New York 12801
Death Certificate Filed District Number
City, Town or Village Glens Falls 5601 Register Number
466
Burial Date Cemetery, Crematory or Facility Name
10/28/2019 Pine View Crematory
Entombment
FKCremation
Address
Queensbury, New York
Donation
z❑
Removal
Date
Place Removed
and/or
and/or Held
Hold Address
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Date Poof
❑ Transportation Point of
by Common Shipment
Carrier
Destination
❑ Disinterment
Date
Cemetery Address
Reinterment
Date
Cemetery Address
Permit Issued to
Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home
)1443
Address
53 Quaker Rd, Queensbury, New York 12804
Name of Funeral Firm Making Disposition orto Whom
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Remains are Shipped, If Other than Above
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Address
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Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/28/2019 Registrar of Vital Statistics Xp6erY,VrrdrewCkwtz (Ekctronicad S#aer!%
(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:
Date of Disposition to Place of Disposition /� tonw�_
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(address)
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Q/sedron/
//otnumberJ (grave number)
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Name of Sexton or Person in Charge of P emises �i f Q"`"t k
(p ase print/
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Signature 2'L c
DOH-1556
(07118) D 1 of 2
Public Health Law Sec. 4145(2bj
Receipt
Human remains of
Pine View Cemetery
Official
delivered on
,20
Representing the funeral home named on burial permit
Funeral Directors Reg. or License #