Boyca, Floyd " _, ii CSO
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Floyd Boyea Male
Date of Death Age If Veteran of U.S. Armed Forces,
September 28, 2013 75 War or Dates
t-° Place of Death Hospital, Institution or
Z City, Town or Village Lake George Street Address 304 Blind Rock Road
ILI
Manner of Death x❑Natural Cause n Accident ❑Homicide ❑Suicide n Undetermined n Pending
tti Circumstances Investigation
Medical Certifier Name Title
42 Mark Hoffman M.D.
Address
100 Park Street,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Lake George Lake George
❑Burial Date Cemetery or Crematory
October 1, 2013 Pine View Crematorium
❑Entombment Address
Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
0 and/or Address
E Hold
N
0 Date Point of
cnTransportation 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 01443
Address
53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
t— Remains are Shipped, If Other than Above
2" Address
ig
13'. Permission is hereby granted to dispose of the hum ains dyes riibed abo e as indicated.
Date Issued ? //3 Registrar of Vital Statistics /�� ;l i`�- Li
l v (s' nature)
District Number Lake George Place Lake George
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 1011113 Place of Disposition R /
.L4 J ` ttxk-
2 (address)
W
N
CL
(section) A (Iqt numbere- (grave number)
p Name of Sexton or Person i Charge of Premises Ahoy.... J[at
Z ease print)
W Signature 71 Title CRas=*Aft
(over)
DOH-1555(02/2004)