Granger, Michael NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Michael J Granger Male
Date of Death Age If Veteran of U.S. Armed Forces,
12/03/2017 68 Years War or Dates
-. Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death 0 Natural Cause ❑Accident ❑Homicide ❑Suicide Undetermined ❑Pending
Circumstances Investigation
= Medical Certifier Name Title
Jean Vanauken PA
Address
100 Park St,Glens Falls,New York 12801
• Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 626
- ❑Burial Date Cemetery or Crematory
12/07/2017 Pine View Crematory
❑Entombment, Address
®Cremation Queensbury, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
❑Disinterment
Date Cemetery Address
❑Renterment Date Cemetery Address
Permit Issued to Registration Number
- Name of Funeral Home Regan Denny Stafford Funeral Home 01443
_ Address
53 Quaker Rd,Queensbury,New York 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.
Date Issued 12/06/2017 Registrar of Vital Statistics MertACurtis EsctronicaaySigned
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition I i/i ill Place of Disposition �tiMl�•.r (°„,�}�.._
(address)
(section) (lot number) (grave number)
ems, Name of Sexton or Person in Charge of; remises in-
(p ase print)
Signature
/ttirrr Title (Oftn i
(over)
DOH-1555 (02/2004)