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Knapp, Thomas 41* s'1 NEW YORK STATE DEPARTMENT OF HEA Vital Records Section Burial - Transit Permit , Name First Middle Last Sex Thomas P.Knapp Male Date of Death Age If Veteran of U.S.Armed Forces, 08/11/2018 69 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide El❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title a Michael Miles MD Address 100 Park St,Glens Falls,New York 12801 `' Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 384 1❑Burial Date C1emetery or Crematory 08/13/2018 Pine View Crematory ❑Entombment Address ®Cremation Queensbury, New York Date Place Removed Z❑Removal and/or Held and/or Address 1 Hold Date Point of ❑Transportation Shipment by Common Destination Carrier A ❑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 Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom I- Remains are Shipped, If Other than Above Address CC 11.1 ArPermission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/13/2018 Registrar of Vital Statistics Rp6ertA Curtis(ECectronicaCCySigned) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition g I itV Place of Disposition g..U..P, dfi<-•, W (address) i (section) (lot nuI er) (grave number) Q ,Name of Sexton or Person in Charge of remises P^ito f t✓ e1,%"4'r Z (please punt) ILI Signature g G' Title (401416K. (over) DOH-1555(02/2004)