Ireland, Daniel NEW YORK STATE DEPARTMENT OF HEALTH I 1 ti t
Vital Records Section A. Burial - Transit Permit
Name First Middle Last Sex
Daniel Ireland Male
Date of Death Age If Veteran of U.S. Armed Forces,
March 16, 2011 49 War or Dates
Place of Death Hospital, Institution or
ZCity, Town or Village Glens Falls Street Address Glens Falls Hospital
O Manner of Death X Natural Cause H Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
C Joseph Mihindu,MD
Address
20 Murray Street Glens Falls NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls S 60 I 13 L f
❑Burial Date Cemetery or Crematory
March 18, 2011 Pine View Crematorium
❑Entombment Address
ID Cremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
co
O Date Point of
NTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Home 01464
Address
53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
I Remains are Shipped, If Other than Above
2. Address
Ce
w
a.
Permission is hereby granted to dispose of the human remains de ribed abo as i ' ted.
Date Issued 3/i % ! t/ Registrar of Vital Statistics ,I% '
(signs ure)
District Number 56a 1 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 3-L3--1I Place of Disposition . ,,.t t,,,J ('r 'f (nvv%.
W (address)
co
re
0 (section) Attil
(lot flu ) (grave number)
pName of Sexton or Perso in Charge of emises e- J t h
Z (please print)
W `1 l
Signature C !l�,L. Title fc/1IA-j
(over)
DOH-1555(02/2004)