Silic, Kyle NEW YORK STATE DEPARTMENT OF HEALTH S7
Vital Records Section •• ' Burial - Transit Permit
Name First Middle Last Sex
Kyle J. Silic Male
Date of Death Age If Veteran of U.S. Armed Forces,
March 19, 2011 18 War or Dates
Place of Death I Hospital, Institution or
City, Town or Village So. Glens Falls I Street Address 611 Gansevoort Rd.
Manner of Death Natural Cause Accident Homicide X Suicide Undetermined Pending
Lii
Circumstances Investigation
km Medical Certifier Name Title
0 J.Paston MD
Address
211 Church Street, Saratoga Spring,NY
Death Certificate Filed District Number Register Number
City, Town or Village Town of Moreau 1/57, ,
❑Burial Date Cemetery or Crematory
March 22, 2011 1 Pine View Crematorium
❑Entombment Address
❑x Cremation 21 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
u) Transportation Shipment
p by Common Destination
Carrier
Disinterment Date ' Cemetery Address
Reinterment Date 1 Cemetery Address
Permit Issued to j Registration Number
Name of Funeral Home Regan & Denny Funeral Home 01464
Address
53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
1- Remains are Shipped, If Other than Above
5 Address
OC
UJ
Permission is hereby ranted to dispose of the human remains described above as '//ndicated.
Date Issued 02 I Registrar of Vital Statistics 10A v r� rn• as
(signature)
District Number LJ570? Place Town of Moreau
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
wDate of Disposition 3'2S--Ii Place of Disposition Po( 1144.4 CFO,*i f4-....
2 (address)
W
U)
Q: (section) (lot Triter) (grave number)
Q Name of Sexton or Person in Charg f Premises ()I.
r.,t /t„oait
Z7,inift,,,
(please print)
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SignatureTitle CPF Ad�.1
(over)
DOH-1555(02/2004)