Franklin, Dennis . , 07X
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Dennis C. Franklin Male
Date of Death Age If Veteran of U.S. Armed Forces,
December 19, 2012 70 War or Dates
Place of Death Hospital, Institution or
2 City, Town or Village Glens Falls Street Address Glens Falls Hospital
taiti Manner of Death x❑Natural Cause I I Accident 1 1 Homicide n Suicide n Undetermined [1 Pending
til Circumstances Investigation
W Medical Certifier Name Title
G John Stoutenburg
Address
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 5 g
❑Burial Date Cemetery or Crematory
December 21, 2012 Pine View Crematorium
❑Entombment Address
Cremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
ZO ❑Removal and/or Held
and/or Address
H Hold
CO
O Date Point of
NTransportation Shipment
p by Common Destination
Carrier
pi Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
E. Address
C
0.. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued /2/2. / // �, Registrar of Vital Statistics LAD C ty- g ^,
(signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this pekmit on:
w Date of Disposition 1L=-2y-iZ Place of Disposition ZtUt{a Cni)tetvi.
2 (address)
U)
(section) 4(lot
number) (grave number)
Z Name of Sexton or Pers in Charge of P mises f)J L.. p'f J
(plea4e print)
Signature Title C1 `)AVL
(over)
DOH-1555(02/2004)