Buttles Sr., Bernard NEW YORK STATE DEPARTMENT OF HEALTH 70(3
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Bernard F. Buttles,Sr. Male
Date of Death Age I If Veteran of U.S. Armed Forces,
8/26/2018 78 War or Dates NA
Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls,NY Street Address Glens Falls Hospital
pManner of Death n Natural Cause Accident Homicide Suicide Undetermined n Pending
W Circumstances Investigation
W Medical Certifier Name Title
C Philip J.Gara,Jr. MD
Address
327 Broadwary,Fort Edward,NY
Death Certificate Filed District NumberO, 1 Register Number L/I�J
City, Town or Village Glens Falls NY
El Burial Date Cemetery or Crematory
❑ August 28,2018 Pine View Crematorium
Entombrtient Address
®Cremation 51 Quaker Road,Queensbury,NY 12804
Date Place Removed
Z ElRemoval J and/or Held
and/or Address
H Hold
N
O Date Point of
O.
0 Transportation Shipment
p by Common Destination
Carrier
n Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan& Denny Funeral Home 01444
Address
94 Saratoga Avenue,South Glens Falls,NY 12803
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
2 Address
C
W
O.
Permission is he eby granted to dispose of the huma remains described above a indi ated.
Date Issued 6 R aoi�' Registrar of Vital Statistics / 2.?) 377 o --�
(signature)
District Number 5 o ( Place A ' �f
I certify that the remains of the decedent identified above w; e disposed of in accords ce with this permit on:
W Date of Disposition $Mt IN Place of Disposition elk/ (re wtt-
u (address)
W
N
a' (section) (lot tuber) (grave number)
pName of Sexton or Person in Charge of Premises ih,Opt_ ,�t+4a-
W (please pn t)
Signature ..,4_ Title ACE A"IM,
(over)
DOH-1555(02/2004)