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Behuniak Jr, Michael 231 NEW YORK STATE DEPARTMENT OF HEALTH , Vital Records Section Burial - Transi ' ermit Name First Middle Last Sex Michael t Peter Behuniak,Jr. Male Date of Death e If Veteran of U.S. Armed Forces, March 25, 2016 76 War or Dates Navy 1958-1964 Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death — Undetermined Pending g Natural Cause n Accident _Homicide n Suicide Circumstances Investigation Medical Certifier Name Title Robert Sponzo,MD Address > 100 Park Street,GlensFalls,NY 12801 Death Certificate Filed District Number Register Number r r, City, Town or Village 56 Q ( 16 , ❑Burial Date Cemetery or Crematory March 28, 2016 Pine View Crematorium ❑Entombment Address ©Cremation 51 Quaker Road, Queensbury,NY 12804 Date Place Removed ZZ ri❑Removal and/or Held and/or Address E Hold co 0 Date Point of Nn Transportation Shipment a by Common Destination Carrier Disinterment Date Cemetery Address n Reinterment Date Cemetery Address :: Permit Issued to Registration Number '', Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Road, Queensbury, NY 12804 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 3 /Z-k 1 i 6 Registrar of Vital Statistics W QX-k LV✓ (sign ure) District Number 5 6 ©1 Place 6 LDS r1.G, i \ s, I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: w Date of Disposition 3 J3I//L Place of Disposition 12l Ft,. &.0►�.- (address) W CO Ct (section) pi ` (lot numb (grave number) pName of Sexton or Person in Charge of Premises Ul.n, �ndq' Z please print) W a '�'�� 1 Title (TX Mg Signature (over) DOH-1555(02/2004)