Newman, Richard NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
r3 Name First Middle Last Sex
�"' Richard A Newman Male
./r
:' Date of Death Age If Veteran of U.S. Armed Forces,
fr April 8, 2015 87 War or Dates
f Place of Death Hospital, Institution or
' City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death
g Natural Cause I I Accident I I Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
William Borgos,
:ixr Address
,Ki Glens Falls,NY
;fr ; Death Certificate Filed District Number Register Number
;rf� City, Town or Village Glens Falls,NY 5601 /95--
7. ❑Burial Date Cemetery or Crematory
April 10, 2015 Pine View Crematorium
❑Entombment Address
0 Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
• and/or Address
H Hold
N
O Date Point of
NTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
: : Permit Issued to Registration Number
::: Name of Funeral Home Regan Denny Stafford 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
Address
:rr Permission is herby ranted to dispose of the human r mains described ve as indica -d.
rjf
Date IssuedL pg o�lS Registrar of Vital Statistics t �� `?2
r f; Z (signature)
▪ District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were sposed of in accordance with this permit on:
Z
W Date of Disposition (jig)hs-- Place of Disposition 17,4. C fOrc_•
2 (address)
W
N
CL (section) (lot number) (grave number)
QName of Sexton or Person in Charge of Premises 14,* 1—
Z (please print)
W ,�, Title Cizt'kkipt
Signature 'L
(over)
DOH-1555(02/2004)