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Stewart, Charles --#10 Y NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit ' Name First Middle Last Sex Charles L. Stewart Male Date of Death Age If Veteran of U.S. Armed Forces, January 13, 2017 92 War or Dates 1942- 1946 Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death C Natural Cause n Accident n Homicide Suicide 1-1 Undetermined n Pending Circumstances Investigation Medical Certifier Name Title Noelle Stevens MD r Address • %f 100 Broad St. Glens Falls,NY 12801 Death Certificate Filed District Number Register Register Number 02 City, Town or Village Glens Falls,NY ❑Burial Date Cemetery or Crematory January 19, 2017 Pine View Crematorium ❑Entombment Address ©Cremation 51 Quaker Road, Queensbury,NY 12804 Date Place Removed Z ❑Removal and/or Held and/or Address N Hold U) 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 Regan Denny Stafford Funeral Home 01443 • Address . f 53 Quaker Road, Queensbury,NY 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above >f Address ▪ Permission is hereby granted to dispose of the human remains described above aslndicated. Date Issued ) II 7 12-0 l'pegistrar of Vital Statistics l.N CM,),- S�—W-'\/• (signature District Number 5()Q 1 Place 6 �s S 1 1 S �)j .i ) I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z �t mi Date of Disposition I/lot tl Place of Disposition .ga..lit (INAr tr.u_ W (address) (I) O (section) {A/(lot numbe (grave number) ZZ Name of Sexton or Person in Charge of Premises G(c �r+ ( se print) ILI Signature s( Title a9vf 1M'Pt (over) DOH-1555(02/2004)