Eddy, Christopher NEW YORK STATE DEPARTMENT OF HEALTH
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Vital Records Section Burial - Transit Permit
:ig: Name First Middle Last Sex
:.a : Christopher Eddy Male
▪ Date of Death Age If Veteran of U.S. Armed Forces,
✓ November 20, 2015 38 War or Dates
✓ :' Place of Death Hospital, Institution or
: City, Town or Village Lake George Street Address 78 Mohican St.
Manner of Death Natural Cause Accident X Homicide Suicide Undetermined Pending
Circumstances Investigation
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ram;? 50 Broad St. Waterford,NY 12188
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❑Burial Date Cemetery or Crematory
November 25, 2015 Pine View Crematorium
❑Entombment Address
❑x Cremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
ZRemoval and/or Held
and/or Address
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O Date Point of
uTransportation Shipment
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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 herebgranted to dispose of the huma remains describe above as i dicat d.
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Date Issued i Registrar of Vital Statistics
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__ District Number �r-'�� � Place 1'�Z�
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r` I certify that the remains of the decedent identified above were disposed of in accordance w' this permit on:
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Signature L� Title (MIPi
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DOH-1555(02/2004)