Jary, Paul NEW YORK STATE DEPARTMENT OF HEALTH_.., ,.--
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Paul W. Jary Male
:;j:' Date of Death Age If Veteran of U.S. Armed Forces,
June 10, 2015 90 War or Dates
iPlace of Death Hospital, Institution or
City, Town or Village Queensbury Street Address 23 Olde Coach Road
Er Manner of Death I Xi Natural Cause 1 I Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
i Medical Certifier Name Title
M. Gumuka
Address
:;:;3 Irongate,Glens Falls,NY 12801
:i' Death Certificate Filed District Number Register Number
City, Town or Village Queensbury 5657 ) (.1:
❑Burial Date Cemetery or Crematory
Ill Entombment June 11, 2015 Pine View Crematorium
Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
ZO n Removal and/or Held
and/or Address
Hold
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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
;}+: Remains are Shipped, If Other than Above
Address
'• Permission is hereb granted�^ to dispose of the human r m ins described ab e as indicated.
Date Issued it t:40e Registrar of Vital Statistics �/s '�Q—t____,
(signature)
v• e District Numbe. Place Queensbury,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W (
Date of Disposition 6Iiaj15" Place of Disposition Raw, �"',.,,,ta,�
2 (address)
W
U)
CL (section) /J�, (lot numb (grave number)
pName of Sexton or Person in Charge of Premises l/i• i1'
Z please print)
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Signature Title rahrimpiet
(over)
DOH-1555(02/2004)