Varney, Eugen o 1 if trig
NEW YORK STATE DEPARTMENT OF HEALTH Burial _ Transit Permit
Vital Records Section ,..
:' Name First Middle Last Sex
rff Eugene W. Varney Male
::rr Date of Death Age If Veteran of U.S. Armed Forces,
;r.�r'•'� June 10, 2016 81 War or Dates
Place of Death •Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
?i Manner of Death I'I Natural Cause Accident Homicide Suicide Undetermined Pending
Ali Circumstances Investigation
Medical Certifier Name „ itle
a m 1i 0 can mo 00_0 'Y. 0
Address r : 1' I Q Ci d 6-fi c.ct 1 C-1 I cn J (,I 11 3 t k 2_,(0
Death Certificate Filed District Number3-6,6/ Register,*
City, Town or Village
❑Burial Date Cemetery or Crematory
June 13, 2016 Pine View Crematorium
❑Entombment Address
❑x Cremation 51 Quaker Road, Queensbury, NY 12804
Date Place Removed
ZZ I I Removal and/or Held
and/or Address
r,Z Hold
N
O Date Point of
yI I Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
rrf Permit Issued to Registration Number
;r , Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury,NY 12804
:� r Name of Funeral Firm Making Disposition or to Whom
: .,, Remains are Shipped, If Other than Above
Address
1
Permission is hereby granted to dispose of the human remains described above as indicated.
a
Date Issued 61/ 3 1 l 6 Registrar of Vital Statistics c -.--�LN
•:
(signature)
`ir
District Number 5 (, 01 Place G �Q vv S 115 , N y
f:
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z ((N� 1 /���
tu Date of Disposition J�1i6 Place of Disposition t�Ott` per--
(address)
W
N d' (section) 4 (lot nur) (grave number)
pName of Sexton or Person in Charge of Premises ` llA
z
/�.
C//L' (please print)
W
Signature Title Peretkrk
(over)
DOH-1555(02/2004)