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Ziarnik, Henry NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex HenryW. Ziarnik male Date of Death Age If Veteran of U.S. Armed Forces, August 9, 1996 61 War or Dates 1952-1956 Place of Death Hospital, Institution or City, Town or Village City of Glens Falls Street Address Manner of Death ®Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title Paul Bachman MD Address Warrensb ra, New York Death Certificate Filed District Numbers 0/ RegisterNumber City, Town or Village City of Glens Falls Date Cemetery or Crematory ❑burial August 12, 1996 Pine View Crematory Address ©Cremation Queensbury, New York 12804 Date Place Removed 8❑Removal and/or Held ••.. and/or Address Hold Q Date d Point of N❑Transportation Shipment by Common Destination Carrier ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan and Denny Funeral Service, Inc. 01583 Address 53 Quaker Road, 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 a-bbog s ind' to . Date Issued_ i P z pro Registrar of Vital Statistics si ( 9nature) District Number Place Z I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: f- z Date of Disposition Qj Place of Disposition L p1 U 1 o� � \ eM +� IZ � (address) Uj 0 >� (sectio ) t mber (grave number) GName of Sexton or Person in Charge of Premises f' lz 4 �l� g (please print) d c Signature Title d R DOH-1555 (10/89) p. 1 of 2 VS-61