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NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial _ Transit Permit
:. Name First Middle Last Sex
Aaron M. Mahoney Male
f Date of Death Age If Veteran of U.S. Armed Forces,
•
:1 April 20,2016 35 War or Dates
''': Place of Death Hospital, Institution or
' City, Town or Village Glens Falls, NY YStreet Address Glens Falls Hospital
: Manner of Death I I Natural Cause Accident Homicide Suicide Undetermined x Pending
Circumstances Investigation
Medical Certifier Name Title
M Michael Sikiiriica MD
Address
New Scotland Ave,Albany,NY
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls,NY 5 (Do 1 2 E cg
❑Burial Date Cemetery or Crematory
April 22, 2016 Pine View Crematorium
❑Entombment Address
❑x Cremation 51 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
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0 Date Point of
NTransportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
1-1 Reinterment Date Cemetery Address
: Permit Issued to Registration Number
;: 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
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued S 60 I Registrar of Vital Statistics W C .4. LA.)(signat e)
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` ::: District Number 55 6°i Place G �v'‹ s ,/�/(-1
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I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition V2511b Place of Disposition 1y0,r..r O, atditu....
W (address)
Cl)
C (section) (lot number) (grave number)
pName of Sexton or Person in Charge of Premises /rt/1 �Q.i^ I
Z (p ase print)
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Signature Title af...M110t.
(over)
DOH-1555(02/2004)