Strader, David NEW YORK STATE DEPARTMENT OF HEALTH +Rir i 73.3
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
David Rennell Strader Male
Date of Death Age If Veteran of U.S. Armed Forces,
10/1/2017 \62 War or Dates n/a
Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address 20 Elm Street Apt 406
W
Manner of Death C Natural Cause C Accident ❑Homicide n Suicide n Undetermined 1-1 Pending
Circumstances Investigation
W Medical Certifier Name Title
0 Stephen Wrzesinski,MD
Address
Albany,NY
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls,NY 5601 .5 0/
❑Burial Date Cemetery or Crematory
❑Entombment Address
3, 2017 Pine View Crematorium
Address
®Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z n Removal and/or Held
and/or Address
F Hold
t/)
O Date Point of
O.
❑Transportation Shipment
p by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped, If Other than Above
2 Address
0. Permission is hereby granted to dispose of the human remains descri ed above as i is ted.
Date Issued I 0( 3/ 2 U(7 Registrar of Vital Statistics ,yht
(signature)
District Number 5 6 0 / Place G (QAA5 cok \\5
r
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ill Date of Disposition 10/3 p Place of Disposition -PJ 4 dye, PYAI&I.Ot iV►�
LIJ (address)
W
(section) 7f(kit umber) r (grave number)
pName of Sexton or Person in Charge of Premises J Ca (
'Z (pl se print)
Signature Title !triMAV
(over)
DOH-1555(02/2004)