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Livingston, Richard I • / 7g NEW YORK STATE DEPARTMENT OF HEALTH • Vital Records Section y ,� Burial - Transit Permit Name First Middle Last Sex Richard Livingston Male Date of Death Age If Veteran of U.S. Armed Forces, October 22, 2016 82 War or Dates Place of Death ••Hospital, Institution or 2 City, Town or Village Glens Falls Street Address Glens Falls Hospital tiJ ct Manner of Death ❑X Natural Cause Accident Homicide Suicide n Undetermined n Pending 141 Circumstances Investigation fa Medical Certifier Name Title Narredl Siddiqui Dr. Address 100 Park Street,Glens Falls,NY 12801 „..-Death Certificate Filed >. ( ( District Numb /' Register N e ityjown or Village Itn QBurial Date Cemetery or Crematory October 29, 2016 Pine View Crematorium ❑Entombment Address ©Cremation 51 Quaker Road, Queensbury,NY 12804 Date Place Removed ZO ❑Removal and/or Held and/or Address H Hold N O Date Point of Nn Transportation Shipment 'p by Common Destination Carrier El Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan& Denny Funeral Home 01444 Address 94 Saratoga Avenue, South Glens Falls,NY 12803 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address t ti11.A Permission is hereby granted to dispose of the human remains described above as indicated. s Date Issued 10/ 2911 6 Registrar of Vital Statistics CA. .P"4-- (sign District Numbers A Place , &ems ( I g h) I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition ;o%31 p/h Place of Disposition (t +z o t,.• 2 (address) W N (section) (lot number) r (grave number) OName of Sexton or Person in Charge of Premises Fes , c. ji'- Z (pl ase print) W Signature Title (WI:.►k0'1i�i/� s (over) DOH-1555(02/2004)