Hemenway, John 4 i($
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
John Murdoch Hemenway Male
Date of Death Age If Veteran of U.S. Armed Forces,
tg
- 03/28/2018 90 Years War or Dates 1945-1946
1— Place of Death Hospital, Institution or
W City, Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
Manner of Death X❑Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
0 John Quaresima MD
Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 157
. Date Cemetery or Crematory
<_.. ❑Burial
03/30/2018 Pine View Crematory
❑Entombment Address
®Cremation Queensbury, New York
Date Place Removed
K ri❑Removal and/or Held
and/or Address
Hold
Date Point of
Q Transportation Shipment
C by Common Destination
Carrier
,ElDisinterment Date Cemetery Address
' Reintermenti_j 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
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/29/2018 Registrar of Vital Statistics /g6ertA Curtis(E(ectronica((ySigned)
(signature)
District Number 5601 Place Glens Falls, New York
ii I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 'lit Ili Place of Disposition f?,,f,./ �,,,,,•fel--.
a (address)
W
(I)
IX (section) � (lot pumber (grave number)
pName of Sexton or Person in Charge of Pre ises `�'►, >44"
Z (pase print)
W Signature 4 Title (''
(over)
DOH-1555(02/2004)