Turner,Jaxon Everett NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Jaxon Everett Turner Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/02/2020 2 Hrs.21 Mins. War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
W
Manner of Death ❑X Natural Cause Accident Homicide Suicide ❑Undetermined Pending
Circumstances Investigation
IW• Medical Certifier Name Title
a Kerry Wickert MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 504
Burial Date Cemetery,Crematory or Facility Name
11/09/2020 Pine View Crematory
❑Entombment Address
O Cremation Queensbury,New York
▪Donation
Z ❑Removal Date Place Removed
Q and/or and/or Held
Hold Address
CO
O. Date Point of
CO❑Transportation
Q by Common Shipment
Carrier Destination
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
l~ Remains are Shipped,If Other than Above
• Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/09/2020 Registrar of Vital Statistics Rp6ertAmirew attic(E6ectrouicall:ySrgnea
(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:
Z
Date of Disposition It ilol70 Place of Disposition 476..14,.
ZIT--
2 (address)
W
(section) got numb) (grave number)
8 Name of Sexton or Person in Charge of Premises
Z (pl se print)
W Signature Title
DOH-1555 07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 1418 1 I
Receipt
Human remains of delivered on , 26e u
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#