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Howard, Stephen NEW YORK STATE DEPARTMENT OF HEALTH 4, `4 % ft Z Vital Records Section Burial - Transit Permit Name First Middle Last Sex Stephen F Howard I Male Date of Death Age If Veteran of U.S. Armed Forces, May 14,2011 55 War or Dates No iPlace of Death Hospital, Institution or City, Town or Village Glens Falls 1 Street Address Glens Falls Hospital Manner of Death I I 1 Xj Natural Cause I ,Accident Homicide I I Suicide Undetermined -Pending ILICircumstances Investigation g Medical Certifier Name Title Paul Backman Dr. Address 3767 Main Street,Warrensburg,NY 12885 :.: Death Certificate Filed District Number Re I nber City, Town or Village Glens Falls 5601 c lc -AD ❑Burial Date Cemetery or Crematory May 16, 2011 Pine View Crematorium ❑Entombment Address ©Cremation 21 Quaker Road, Queensbury, NY 12804 Date Place Removed Z I I Removal and/or Held Q and/or Address F' Hold N 0 Date Point of co Transportation Shipment as by Common Destination Carrier Disinterment Date 1 Cemetery Address Reinterment Date Cemetery Address I Permit Issued to Registration Number z:? Name of Funeral Home Singleton-Healy Funeral Home 01622 I Address 407 Bay Road, Queensbury,NY 12804 w;a Name of Funeral Firm Making Disposition or to Whom l Remains are Shipped, If Other than Above N Address lli • Permission is here y ranted to dispose of the human remains descri d.ab ve indic d • Date Issued ___j_ �/� Registrar of Vital Statistics � (signature) 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: WDate of Disposition 5-i1-t1 Place of Disposition -PatLtc ,i +.nctdrisd4:. W (address) co re (section) ii. (lot number) (grave number) Q Name of Sexton or Pers n in Charge of Premises [ ^riy' le- ow+rtN Z ` (please print) W Title CrtI Signature .roL. (over) DOH-1555(02/2004)