Warner, Steven NEW YORK STATE DEPARTMENT OF HEALTH r il ,# 3YS'
Vital Records Section Burial - Transit Permit
xi Name First Middle Last Sex
: Steven Warner Male
i Date of Death Age If Veteran of U.S. Armed Forces,
n May 4, 2016 61 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address 36 Grand Street
• Manner of Death I�( Natural Cause Accident n Homicide Suicide Undetermined Pending
%�'' Circumstances Investigation
Medical Certifier Name Title
Philip J.Gara Dr.
rl Address
:.....4 327 Broadway,Fort Edward,NY 12828
Death Certificate Filed District Number Register Number
r"r City, Town or Village$_� 9 Glens Falls 5601 2`. Qi
❑Burial Date Cemetery or Crematory
May 6, 2016 Pine View Crematorium
❑Entombment Address
❑x Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
i Hold
07
0 Date Point of
05 n Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
;.;r% Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
:•r:•; 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.
:•: Date Issued 5/S 1% b Registrar of Vital Statistics W C JISr,
r (signat )
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
s
W 0 ./
�� l�Date of Disposition S�lo � Place of Disposition c rZrr� ti.....
ill
(address)
CO
W (section) (lot number (grave number)
pName of Sexton or Person in Charge of Premises (itr ; ti.e'
Z (�please print)
W
Signature Title ( 011pD-
(over)
DOH-1555(02/2004)