Schwenzfeier Jr., Edward - s lli
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
'+' Edward F Schwenzfeier,Jr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
February 8, 2017 57 War or Dates
Place of Death Hospital, Institution or
f City, Town or Village Glens Falls Street Address Glens Falls Hospital
: Manner of Death n Natural Cause n Accident n Homicide n Suicide ❑Undetermined n Pending
. Circumstances Investigation
',<; Medical Certifier Name Title
•' ` William Cleaver,MD
Address
100 Park Street,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
r City, Town or Village Glens Falls 5601 2 Ci
❑Burial Date Cemetery or Crematory
February 9, 2017 Pine View Crematory
❑Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z ❑Removal and/or Held
and/or Address
t_; Hold
O Date Point of
y ❑Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
/ 53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
t Date Issued Z j4 (i 7 Registrar of Vital Statistics clv—. Lti-i\ IW
F (signature)
District Number 5601 Place Glens Falls, l' L0.4
I certify that the remains of the decedent identified above were disposed of in ppaccordance with this permit on:
Ili Date of Disposition 21 ID I ri Place of Disposition �,v,V �• C+*%S,Tor..
(address)
Cl)tii
IX (section) (lot number) (grave number)
p Name of Sexton or Person in Charge of Premises Aegy ., , -vM
Z (please print)
W
Signature 4 Title (i k"ltt
(over)
DOH-1555(02/2004)