Warner, Christopher NEW YORK STATE DEPARTMENT OF HEALTH
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Vital Records Section Burial - Transit Permit
: Name First Middle Last Sex
?• Christopher E Warner Male
:;:. Date of Death Age If Veteran of U.S. Armed Forces,
: October 6, 2014 61 War or Dates
'•'r Place of Death Hospital, Institution or
,;, City, Town or Village Queensbury Street Address 57 Veterans Road
Manner of Death I XI Natural Cause n Accident Homicide Suicide Undetermined —Pending
:t•
• : - Circumstances Investigation
Medical Certifier Name Title
r Timothy Murphy Coroner
Address
:K1.1 52 Haviland Ave. Glens Falls,NY 12801
ti;; Death Certificate Filed District Number Register Number
_,:;:� City, Town or Village Queensbury .�a,c r'l c
❑Burial Date Cemetery or Crematory
❑Entombment October 8, 2014 Pine View Crematorium
Address
{0 Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
Hold
N
O Date Point of
N I i Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
I I Reinterment
Date Cemetery Address
jPermit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
._i: Address
:::::S1 53 Quaker Road, Queensbury,NY 12804
.: Name of Funeral Firm Making Disposition or to Whom
1 +; Remains are Shipped, If Other than Above
Address
▪.:.; Permission is/r hereby
^granted to dispose of the human e ains describe��e asindicated.
••`sr 1& �i I,; J `f 9 'r`��1 Date Issued � Registrar of Vital Statistics Cam_
�^ (signature)
e)
:: District Numbe' 3 fl Place Queensbury
I certify that the remains of the decedent identified above we disposed of in a dance with this permit on:
Z ,/
at Date of Disposition/04-( f Place of Disposition / VA/L/ /ItJ ,jC f401 �
2 (address)
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0; (section) t number) (grave number)
p :::: SSext0n
or shf Premises Ill
ure Title ' S-i t
(over)
DOH-1555(02/2004)