Many, Richard NEW YORK STATE DEPARTMENT OF HEALTH r 61
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Richard C. Many Male
Date of Death Age If Veteran of U.S. Armed Forces,
December 23, 2012 85 War or Dates
f,;, Place of Death Hospital, Institution or
pCity, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death ❑X Natural Cause Accident Homicide Suicide n Undetermined Pending
W Circumstances Investigation
Au• Medical Certifier Name Title
Ct Sean Bain,MD
Address
100 Park Street,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 SErEr
❑Burial Date Cemetery or Crematory
December 26, 2012 Pine View Crematory
❑Entombment Address
11 Cremation Quaker Road, Queensbury, NY 12801
Date Place Removed
Z Removal and/or Held
O and/or Address
N Hold
Cl)
O Date Point of
Nn Transportation Shipment
p by Common Destination
Carrier
Li Disinterment Date Cemetery Address
n 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
I— Remains are Shipped, If Other than Above
IAddress
W
IL
Permission is hereby granted to dispose of the human remains/� �4� / described
above a indi e .
Date Issued 2O/Z Registrar of Vital Statistics
(signature)
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 E2-n-it Place of Disposition reVvv t�,tmcloc,0,-
2 (address,
W
Cl)
W (section) (lot number) (grave number)
Q Name of Sexton or Person in Charge of Premises �to r �tii F
Z (please print)
lu �
Signature L *r' Title C1244 fttoQ,
(over)
DOH-1555(02/2004)
i