Wright, Daniel NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Daniel Eric Wright Male
Date of Death Age If Veteran of U.S. Armed Forces,
12/28/2017 71 War or Dates NA
2 Place of Death Hospital, Institution or
City, Town or Village Glens Falls,NY Street Address 140 Bay St. Apt#2,Glens Falls,NY
p Manner of Death j Natural Cause _Accident El Homicide n Suicide 1-1 UndeterminedPending
Circumstances Investigation
w Medical Certifier Name Title
0 Paul Bachman MD
Address
Warrensburg,NY
Death Certificate Filed District Number // Register Number
City, Town or Village Glens Falls,NY 56 t/ ego
❑Burial Date Cemetery or Crematory
Entombment 01/02/2018 Pine View Crematory
Address
®Cremation Quaker Rd.,Queensbury,NY
Date Place Removed
Z Removal and/or Held
2 and/or Address
L. Hold
Cl)
O Date Point of
N ❑Transportation Shipment
by Common Destination
Carrier
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 Rd.,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped, If Other than Above
2 Address
W
a' Permission is hereby granted to dispose of the human re ains d cribed above as hid' ated.1!
l
Date Issued d Registrar of Vital Statistics '�ort 1,9�-17 - i
(signatLre)
District Number �/.‘16 / Place 4(-eri/1,.O ixX4 > l
F I certify that the remains of the decedent identified above were disposed of in accord ce with this permit on:
Z (�
ta Date of Disposition I/lilt Place of Disposition �,w ,./
W (address)
N
re (section) Ja (lo number),t (grave number)
0
p Name of Sexton or Person in Charge of Premises �,tr�, ,�,r f"
'Z 4 (base print)
Signature Title k4fr+trY1-
(over)
DOH-1555(02/2004)