Hintze, Ronald NEW YORK STATE DEPARTMENT OF HEALTH
. Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Ronald Frederick Hintze Male
Date of Death Age If Veteran of U.S. Armed Forces,
12/06/2015 72 years War or Dates 1961-1964
1.-: Place of Death Hospital, Institution or
Z City, T Ot 404102X Glens Falls Street Address Glens Falls Hospital
Manner of Death E Natural Cause 0 Accident 0 Homicide 0 Suicide riUndetermined ri Pending
Circumstances Investigation
W Medical Certifier Name Title
Jennifer Donwan DO
Address
100 Park Street Glens Falls, Ny
Death Certificate Filed District Number Register Number
City, Td XAN NXiXelcitX Glens Falls _ 5601 580
0Burial Date Cemetery or Crematory
12/08/2015 Pine View Crematorium
i 0 Entombment Address
["Cremation Queensbury, NY 12804
Date Place Removed
Z 0 Removal and/or Held
2 and/or Address
t Hold
Cl}
0 Date Point of
0 Transportation Shipment
0 by Common Destination
Carrier
0 Disinterment Date Cemetery Address
0 Reinterment Date Cemetery Address
Permit Issued to Registration Number
i> Name of Funeral Home Wilcox& Regan Funeral Home 01821
Address
11 Alqonkin Street Ticonderoga, N Y
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address '
EE
` Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/08/2015 Registrar of Vital Statistics )CA-,_,e `,rJ
(si ature)
District Number 5601 Place Glens Falls N ki
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certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ill Date of Disposition ja_g_t S Place of Disposition Z,,,, cl('eLi C re ye)c.- or :0 .,
2 (address)
Lti
U)
CC
(section � (lot number) (grave number)
0
Name of Sexton or Person in Charg f Premises I /nis >1� iJiLrlelle
._.--1, (please print)
iLi
Signature 4-1./ Title Cr e nleck ex 1 Ssrr
•
(over)
DOH-1555 (02/2004)