Cady, David 1C
NEW YORK STATE DEPARTMENT OF HEALTH *
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
David Alan Edmund Cady Male
Date of Death Age If Veteran_of U.S. Armed Forces,
5/8/2018 90 War or Dates 1945-1971
. Place of Death Hospital, Institution or
Z City, Town or Village Bolton Street Address 17 Willow Lane
W Manner of Death jJ Natural Cause C Accident ❑Homicide pi Suicide El Undetermined [Pending
Circumstances Investigation
ILI Medical Certifier Name : -\ s._YY e Title
Address C S . � knYll Y� i , l ! 1 31.(1
l �� s �- 1 c� � 2
Death Certificate Filed District Number R gister Number
City, Town or Village Town of Bolton,NY 5675 0
❑Burial Date Cemetery or Crematory
❑Entombment May 10,2018 i Pine View Crematorium
Address
®Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z ❑Removal and/or Held
and/or Address
F- Hold
co
O Date Point of
N ❑Transportation Shipment
p by Common Destination
Carrier
C Disinterment Date Cemetery Address
n Renterment Date ; Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
2 Address
W
a Permission is hereb granted to dispose of the human remains describ d above as indicated.
Date Issued 51 10 ZoIc6 Registrar of Vital Statistics
(sign re)
District Number 5 is5o Place U LT 0 i'4
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
U1Date of Disposition S J,il if s Place of Disposition ,,ih,.., („, .,
2 (address)
Cl)LU
O (section) b 1 (lot numbers (grave number)
pName of Sexton or Person in Charge of remises , ,.
wZ (ease print)
Signature Title (A f
(over)
DOH-1555(02/2004)