Loading...
Vincent, John X --)oi NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex s John A.Vincent Male : Date of Death Age If Veteran of U.S.Armed Forces, • 09/18/2017 94 Years War or Dates 1943-1945 • Place of Death Hospital, Institution or 1,1 City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined El❑Pending Circumstances Investigation isi Medical Certifier Name Title 0 William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number t City, Town or Village Glens Falls 5601 491 ❑Burial Date Cemetery or Crematory 09/20/2017 Pine View Crematory DEntombment Address ®Cremation Queensbury, New York Date Place Removed §n❑Removal and/or Held and/or Address Hold O Date Point of ❑Transportation Shipment O by Common Destination Carrier `' Date Cemetery Address ❑Disinterment ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 A:¢ Address - 53 Quaker Rd,Queensbury,New York 12804 • Name of Funeral Firm Making Disposition or to Whom I. Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/19/2017 Registrar of Vital Statistics ess6ertACurtis EkannticaysIgnei - (signature) District Number 5601 Place Glens Falls, New York 1H I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: UIDate of Disposition q jzilf) Place of Disposition Paz Girrotof/u�, Ill (address) V) W (section) A(lot number) ( (grave number) pName of Sexton or Person in Charge of Premises "st.% J #44iLILtZ (plrint) at Signature �� / Title CJ betaa- (over) DOH-1555 (02/2004)