Sennett, Richard 1 � ft /5'1
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
:n" Name First Middle Last Sex
Richard Byrne Sennett Male
Date of Death Age If Veteran of U.S. Armed Forces,
• March 19, 2011 73 War or Dates Vietnam
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
At
ef•' Manner of Death lXI Natural Cause I I Accident Homicide Suicide Undetermined Pending
tLi Circumstances Investigation
w Medical Certifier Name Title
O T Coppens
Address
r 3 Irongate,Glens Falls,NY 12801
Death Certificate Filed District Number Regist�rJlumber
City, Town or Village Glens Falls 5601CA
❑Burial Date Cemetery or Crematory
—- Entombment March 24, 2011 1 Pine View Crematorium
Address
Li Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
O and/or Address
E' Hold
N
O Date Point of
NTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
I
Permit Issued to Registration Number
Name of Funeral Home Singleton- Healy Funeral Home 01622
p, Address
407 Bay Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
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Ali
• Permission is hereby granted to dispose of the human remains descr" e a ve in ' t d.
Date Issued 037Z`27// Registrar of Vital Statistics
signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z �13-
W Date of Disposition (i Place of Disposition aloo,.., t dd tw
2 (address)
W
U)
Ce
Q0 (section) lot number) (grave number)
Name of Sexton or Person in Charg of Premises al f ol- .. #h,4
Z (please print)
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Signature An k Title C1) ly IqoL
(over)
DOH-1555(02/2004)