Stannard, George NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
?' Name First Middle Last Sex
George Stannard Male
Date of Death Age If Veteran of U.S. Armed Forces,
October 13, 2016 69 War or Dates NA
.1, Place o Death Hospital, Institution or
A Cit ow. or Village Lake George Street Address 3026 Lakeshore Drive
1 Manner of Death u Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined I 'Pending
Circumstances Investigation
Medical Certifier Name Title
Paul F.Bachman MD
Address
3767 Main Street Warrensburg,NY 12885
Death C-.' icate Filed District Number Register Number
City, ow. •r Village Lake George
El Burial Date Cemetery or Crematory
October 19, 2016 Pine View Crennaltftium
❑Entombment Address
®Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
U)
0 Date Point of
N ElTransportation Shipment
aby Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
7 .
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
r Address
" 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 d scribed abov
e as indicated.
Date Issued /O p Y/l io Registrar of Vital Statistics ; 77)7Ct.�-
(signature
"J` District Number�n S i Place �, i Li8hls'
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition /vizi f ll Place of Disposition 1 nz>sL C t*x ,s
2 (address)
W
co
w (section) „/ (lot numbv) (grave number)
pName of Sexton or Person in Charge of Premises CAr=slope Jt.+'►ti�-
Z lease print)
W Signature a ,ii..,drV Title fvii -
(over)
DOH-1555(02/2004)