Eggleston, Floyd NEW YORK STATE DEPARTMENT OF HEALTH 11 til Z
Vital Records Section *- • il. Burial - Transit Permit
Name First Middle Last Sex
Floyd Eggleston Male
Date of Death Age If Veteran of U.S. Armed Forces,
August 22, 2011 76 War or Dates
".e,: Place of Death Hospital, Institution or
E , City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death n Natural Cause ( I Accident C Homicide Suicide n I Undetermined t Pending
Iii Circumstances Investigation
Medical Certifier Name Title
Ri, Desmond DelGiacca,MD
° Address
a` _ Saratoga Spings,NY
Death Certificate Filed District Number / Register Number
City, Town or Village Saratoga Springs,NY VSV/ 3r(
❑Burial Date Cemetery or Crematory
❑Entombment August 26, 2011 I Pine View Crematory
Address
®Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z n Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
N Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
El Reinterment Date Cemetery Address
pi i, Permit Issued to Registration Number
:::i Name of Funeral Home Regan& Denny Funeral Home 01444
:=:': Address
e9 94 Saratoga Avenue, South Glens Falls,NY 12803
;: Name of Funeral Firm Making Disposition or to Whom
Iw* Remains are Shipped, If Other than Above
IAddress —
' Permission is hereby ranted to dispose of the human remai�rS`des ri d alb indicat
Date Issued 21, / Registrar of Vital Statistics 1
(signature)
District Number YOZ___ Place Saratoga Springs,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
ISJ Date of Disposition i/t9 hi Place of Disposition envy,4., �,-v',r f o,
.t..,_
LLI (address)
Co
0 (section) (lot nu�) (grave number)
Z Name of Sexton or Pe son in Charg f Premises 4r.i`t- f4� sPA
(please print`r,
W Signature Title Ctt;,0 4Tm 1L
(over)
DOH-1555(02/2004)