Gaddy, Harold NEW YORK STATE DEPARTMENT OF HEALTH \ Burial - Transit Permit
Vital Records Section t
li Name First Middle Last Sex
Harold Rufus Gaddy Male
rrr: . Date of Death Age If Veteran of U.S. Armed Forces,
: August 5, 2017 89 War or Dates World War II
r: Place of Death Hospital, Institution or
City, Town or Village Bolton Landing Street Address 346 New Vermont Rd
Manner of Death X Natural Cause El Accident ❑Homicide Suicide n Undetermined Pending
Circumstances Investigation
Medical Certifier
Iii
>.1Name Title
Paul Baachman,MD
Address
li Warrensburg,NY
`< Death Certificate Filed District Number Register Number
Il City, Town or Village
❑Burial Date Cemetery or Crematory
❑Entombment August 8, 2017 Pine View Crematory
Address
®Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
G ❑Removal and/or Held
and/or Address
H Hold
N
O Date Point of
O.
❑Transportation Shipment
a by Common Destination
Carrier
n Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
`'1' Permit Issued to Registration Number
it. Name of Funeral Home Regan Denny Stafford Funeral Home 01443
;;r Address
is 53 Quaker Road, Queensbury,NY 12804
"'"' Name of Funeral Firm Making Disposition or to Whom
rr} Remains are Shipped, If Other than Above
Address
~tt.:.j Permission is h re y granted to dispose of the human remains d cribed above s indicated.
k Date Issued / g. 201 7 Registrar of Vital Statistics
? c (signature)
>f` District Number 505 0 Place ( OT bo 4 o
tii
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tuDate of Disposition 8/g)it Place of Disposition jil�ti,. &P.'tr(or ON.
2 (address)
COLLI
Q=O (section) Aot number) (grave number)
p Name of Sexton or Person in Charge of Premises r /' ,�L.4dtit
Z / (plea a print)
Ill Signature it / ,�. Title atk-toibYL
(over)
DOH-1555(02/2004)