Finch, Richard NEW YORK STATE DEPARTMENT OF HEALTH., ��
Vital Records Section i 1 Burial - Transit Permit
Name First Middle Last Sex
Richard J. Finch Male
Date of Death Age I If Veteran of U.S. Armed Forces,
November 25, 2012 82 War or Dates
Place of Death Hospital, Institution or
°Z City, Town or Village 4 QLt • Street Address Glens Falls Hospital
pManner of Death Iv l Natural Cause I I Accident Homicide I j Suicide [Undetermined Pending
:W Circumstances Investigation
w: Medical Certifier Name Title
P. �/A _
Address
i UU //�. �c (,RS ` i(51 1M 1 ZXu
Death Certificate Filed District Number Register ember
City, Town or Village Glens Falls 5601 C/O
❑Burial Date Cemetery or Crematory
November 27, 2012 Pine View Crematorium
❑Entombment Address
CI Cremation 21 Quaker Road, Queensbury,NY 12804
Date j Place Removed
Z Removal ! and/or Held
C i and/or Address
H Hold
co
0 Date Point of
Transportation j Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment
Date ' Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Stafford Funeral Home I 01443
Address
`, 53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
,tom* Remains are Shipped, If Other than Above
'Z Address
W
.. Permission is hereby granted to dispose of the human remains descr'be a ove in c t d.
Date Issued // Z O/ Registrar of Vital Statistics
signature
District Number 5601 Place Glens Falls / / 2/N
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 111 t7/rL Place of Disposition 4��tOttJ C tv�—
2 (address)
W
N
ce
4_ )c (grave number)
(section) �'h of number
Q Name of Sexton or Person in Charge of Premises tU lift"
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Signature ( Title CPR mAT.1(L
//i (over)
DOH-1555(02/2004)