Pirnie, Thomas ,
r ' I Z 3)
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Thomas Victor Pirnie Male
Date of Death Age If Veteran of U.S. Armed Forces,
March 17,2018 69 War or Dates 67-89
001
s Place of Death Hospital, Institution or
City, Town or Village Queensbury,NY Street Address 15 Needlepark Circle,Apt 1
Manner of Death In Natural Cause 0 Accident Homicide n Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
;; William Tedesco,MD
t i
Address
,4_> Glens Falls,NY
Death Certificate Filed ' District Number Register Number
eis
City, Town or Village Queensbury,NY _ 5657 a
❑Burial Date Cemetery or Crematory
March 20,2018 Pine View Crematory
❑Entombment Address
®Cremation Quaker Road,Queensbury,NY
Date Place Removed
Z n Removal and/or Held
and/or Address
F Hold
to
Q Date Point of
N n Transportation Shipment
p by Common Destination
Carrier
n Disinterment Date Cemetery Address
Fl 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
- Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
- ° Permission is hereb granted to dispose of the human remainsre described bove as indicated.
Date Issued 0)-01 O Registrar of Vital Statistics 1pv,_ c
74
,e,,: (signature)
Y
District Number 5657 Place Town of Queensbury,NY 12804
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 3jti IN Place of Disposition 1'..U-d (.«4o-.,
a (address)
W
co
fY (section) Mot number) (grave number)
pName of Sexton or Person in Char a of Premises •, ,aL, cr
Z (ple se print) '
11
Signature Title ac,lit
(over)
DOH-1555(02/2004)