Gonyea, Steven tor
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Steven C. onyea Male
Date of Death Age If Veteran of U.S. Armed Forces,
9/10/2.015 50 War or Dates 1987-1989
}- Place of Death Harrietstown Hospital, Institution or
Z' City, Town or Village Street Address Adirondack Medical Center
p Manner of Death Natural Cause 0 Accident 0 Homicide Suicide n Undetermined 0 Pending
W; Circumstances Investigation
W Medical Certifier Name Title
p Dr. C. Francis Varga MD
Address
PO Box 768 Lake Placid, New York 12946
Death Certificate Filed District Number Register Number
City, Town or Village Harrietstown 1663
❑Burial Date Cemetery or Crematory
9/14/2015 Pine View Crematory
❑Entombment Address
BCremation Queensbury, New York
Date Place Removed
Z❑Removal and/or Held
and/or Address
H Hold
U)
0 Date Point of
NTransportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date . Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Wilcox & Regan Funeral Home 01821_
Address
33 Algonkin Street, Ticonderoga, New York 12883
Name of Funeral Firm Making Disposition or to Whom
1- Remains are Shipped, If Other than Above
2 Address
IX
Ui
a' Permission is hereby granted to dispose of the human remains described • • • e as indicated.
Date Issued 9/13/2015 Registrar of Vital Statistics
It nature)
District Number 1663 Place Village of Saranac Lake
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
t Date of Disposition �Ili)jf c Place of Disposition 1&_ Ce+ ier„--
(address)
LU
th
CC (section) 4 ..... (lot number) ((�' (grave number)
p Name of Sexton or Person i Charge Premises `}uw
lease print)
Signature
ILI f --- Title f +firR-
(over)
DOH-1555 (02/2004)