Krauss, Karl NEW YORK STATE DEPARTMENT OF HEALTH IZ
Vital Records Section - , NI Burial - Transit Permit
Name First Middle Last Sex
Karl E. Krauss 1 Male
Date of Death Age If Veteran of U.S. Armed Forces,
January 2, 2012 82 I War or Dates
Place of Death ; Hospital, Institution or
Z City, Town or Village Glens Falls 1 Street Address Glens Falls Hospital
pManner of Death !XI Natural Cause Accident Homicide Suicide Undetermined Pending
IliCircumstances Investigation
w Medical Certifier Name Title
C Darci Gaiotti-Grubbs,MD
Address
,102 Park Street,Glens Falls,NY
Death Certificate Filed District Number Regis r,N'iraber
City, Town or Village Glens Falls 5601 I `Li
❑Burial Date Cemetery or Crematory
January 4, 2012 Pine View Crematory
❑Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z I !Removal and/or Held
and/or Address
H Hold
O
Date Point of
551 I Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
1 Reinterment
Date I Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan& Denny Funeral Home 01443
Address
53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
2 Address
Ct
Q. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued I/5/1 2 Registrar of Vital Statistics 1,0 WC (signatu i ) V
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
W Date of Disposition I-I- lZ Place of Disposition i,,Ac,) Gs.40cIv,
2 (address)
W
co
0 (section) (lot num (grave number)
Op Name of Sexton or Pers n in Charge of remises a r-,s\-- r D tmft"
Z (please print)
W Signature Title cei;k rt'(dt,
(over)
DOH-1555(02/2004)