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Feingold, Howard NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit 4,- Name First Middle Last Sex Howard Feingold Male Date of Death Age If Veteran of U.S. Armed Forces, 06/11/2018 86 Years War or Dates to Place of Death Hospital, Institution or SCity, Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing p Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide El❑Undetermined El❑Pending Circumstances Investigation • Medical Certifier Name <<` Title Roslyn Socolof MD Address 42 Gurney Ln,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City, Town or Village Queensbury 5657 76 "❑Burial Date Cemetery or Crematory 4-, 06/13/2018 Pine View Crematory y Entombment Address ®Cremation Queensbury Town, New York Date Place Removed ❑Removal and/or Held • and/or Address Hold Date Point of ❑Transportation I Shipment by Common Destination Carrier ❑Disinterment Date Cemetery Address ri❑Reinterment Date Cemetery Address ' Permit Issued to Registration Number ,r:'., Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address • 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address aw Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/12/2018 Registrar of Vital Statistics Caroline.71Barber(ElectronicaltySigned) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition &VV in Place of Disposition f.U, �, or,--- (address) W N l0:' (section) //(lot number) (grave number) pName of Sexton or Person in Charge of Premises 1Ilt.t. S e••.4'$ Z (lase print) SignatureUS Title Nit A TrA (over) DOH-1555 (02/2004)