Reynolds, Duane s
it 13
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
r Name First Middle Last Sex
Duane E Reynolds Male
Date of Death Age If Veteran of U.S. Armed Forces,
December 30, 2014 77 War or Dates
e''•' Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Ei Manner of Death X Natural Cause Accident I I Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
0. Paul Bachman
Address
3767 Main Street,Warrensburg,NY 12885
..... Death Certificate Filed District Numbe5601 Register Number
_'. City, Town or Village Glens Falls 56 d) b 0 '
❑Burial Date Cemetery or Crematory
January 5, 2015 Pine View Crematorium
❑Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
= Hold
Cl)
0 Date gist of
NTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
ii ; Permit Issued to Registration Number
:, Name of Funeral Home Regan & Denny Funeral Home 01444
: f Address
94 Saratoga Avenue, South Glens Falls,NY 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued I- 1 5/1.5 Registrar of Vital Statistics U‘. W_
(signatures)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition i ill is Place of Disposition eat")) ( s,...
2 (address)
W
U)
IY (section) di
!lot n ber) (grave number)
Q Name of Sexton or Person in Charge of Premises -
'LI
Z (please print)
Signature _/- Title m '1Ilrikt
(over)
DOH-1555(02/2004)