Narzynski, Thomas NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Thomas Narzynski Male
Date of Death Age If Veteran of U.S. Armed Forces,
December 1,2013 ) 1 War or Dates
1-, Place of Death Hospital, Institution or
Z City, Town or Village South Glens Falls Street Address 189 Main Street,Apt. 4
Manner of Death n Natural Cause n Accident n Homicide [ Suicide 1---1 Undetermined n Pending
Circumstances Investigation
W Medical Certifier Name Title
G Glen Anderson
Address
161 Carey Rd,Queensbury,NY 12804
Death Certificate Filed District Number Register Number
City, Town or Village South Glens Falls 4524 R
❑Burial Date Cemetery or Crematory
❑Entombment Address
❑Cremation
Date Place Removed
ZZ Removal and/or Held
and/or Address
Hold
0 Date Point of
try Ell Transportation Shipment
p by Common Destination
Carrier
C Disinterment Date Cemetery Address
C Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Home 01444
Address
94 Saratoga Avenue, South Glens Falls,NY 12803
Name of Funeral Firm Making Disposition or to Whom
t- Remains are Shipped, If Other than Above
2 Address
W
a
Permission is herebyr granted to dispose of the human re a ns described ove s indicated.
Date Issued I°2`I ' 13 Registrar of Vital Statistics uC
(signature)
District Number 4524 Place South Glens Falls
i certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tu Date of Disposition it-+t-t3 •Place of Disposition s{a,
(address)
Co
(section) lot num er) (grave number)
Z Name of Sexton or Perso in Charg of Premises f 45 in 4
e v-44
(pleast print)
Signature L. Title C+P.k;frt,yT L
(over)
DOH-1555(02/2004)