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Young, Richard 24 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Richard G Young Male f''�� Date of Death Age If Veteran of U.S. Armed Forces, December 23,2016 84 War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls, Street Address The Pines At Glens Falls t;.: Manner of Death in Natural Cause n Accident n Homicide n Suicide Undetermined El Pending a Circumstances Investigation : Medical Certifier Name Title Kenneth France,MD Address 100 Broad Street,Glens Falls,NY 12801 _ Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5623 ❑Burial Date Cemetery or Crematory ❑Entombment December 27, 2016 Pine View Crematory Address ©Cremation Quaker Road, Queensbury, NY 12804 Date Place Removed On Removal and/or Held r. and/or Address Hold N 0 Date Point of y n Transportation Shipment p by Common Destination Carrier n Disinterment Date Cemetery Address n Reinterment Date Cemetery Address Permit Issued to Registration Number IP Name of Funeral Home Regan Denny Stafford Funeral Home 01443 �/ Address 6}Y` 53 S uaker Road, I ueensbu NY 12804 kit Name of Funeral Firm Making Disposition or to Whom in Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Pi Date Issued i Z.f 2:7 Registrar of Vital Statistics L•)c �\AD. (sign ure) . Distr.frict Number 5623 Place Glens Falls j ? I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: LU Date of Disposition rZ 2.7 Place of Disposition ?pleu rem Greroalot W (address) U) 0 (section) (lot number) (grave number) ZName of Sexton r er on in Charge of Premises JI,, ( vi 9c_424.�lr� W (please print) Signature Title G f2ss?coLp (over) DOH-1555(02/2004)