Snyder, Donald 44
NEW YORK STATE DEPARTMENT OF HEALTH a ) `�1�
Vital Records Section Burial - Transit ermit
Name First Middle • Last Sex
Donald_ _ L. Snyder Male
Date of Death Age I If Veteran of U.S. Armed Forces,
July 17 2012 80 E War or Dates
Place of Death i Hospital, Institution or
Z City, Town or Village Bolton Street Address 148 Coolidge Hill Rd.
pManner of Death ' -l Natural Cause I Accident Homicide I Suicide Undetermined ! Pending
W L-' 'Circumstances Investigation
W Medical Certifier Name Title
CI Christopher Hoy,MD
Address
Park Street, Glens falls,NY 12801
Death Certificate Filed ' District Numbe Register Numbers
City, Town or Village Bolton Landing r56 50 1�
E Burial Date Cemetery or Crematory
July 19, 2012 Pine View Crematorium I
Entombment Address
Li Cremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z ----7 Removal and/or Held
9 and/or - -- -- - - - -- ------- - - -- - ---
Address
I— Hold
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0 Date Point of
0- 1 'ci) Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
r-Reinterment Date Cemetery Address
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Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury, NY 12.504
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above .
E Address
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Permission is hereby granted to dispose of the human remain described� ab ve as indicat d.
y
Date Issued • !- /9 - /� Registrar of Vital Statistics 127X-47- /} ����
(signal).-e,4) er-c) .„e a,
Di:trict Number 56..(} Place Bolton Landing
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1Z 1-TO- a 1 +
!W Date of Disposition 7 Place of Disposition �,y,Vccv CrurlGrIu.....
E (address)
r (section) (lot number) c (crave number)
�.J lc! Name of Sexton or Person in Clarge of Pr mises (trip,yar ewatt
Z (please print)
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Signature Title CHC>r1,TiL
(over)
DOH-1555 (02/2004