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Parry, Robert Jr. NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert Parry Jr Male Date of Death Age If Veteran of U.S.Armed Forces, 12/14/2020 94 Years War or Dates 1945-1946 F.. Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 17 Garrison Road, Queensbury Town, New York 12804 p Manner of Death © Natural Cause El Accident EI Homicide El Suicide Undetermined n Pending VCircumstances Investigation WQ Medical Certifier Name Title Scott Miller PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 226 ©Burial Date Cemetery,Crematory or Facility Name 12/17/2020 Pine View Cemetery ❑Entombment Address ❑Cremation Queensbury Town,New York ElDonation EIRemoval Date Place Removed F and/or and/or Held N Hold Address co Li Transportation Date Point of a 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 H Remains are Shipped,If Other than Above 2 Address cc W a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/15/2020 Registrar of Vital Statistics Caroline JCfegarde Barber(Electronically Signed) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 1 2/2 8/2 0 2 0 Place of Disposition 21 Quaker Rd. Oueensbury, NY 1 2 R 0 4 (address) W New Kenesaw 12—C sec 27 1 (section) //ot number) (grave number) Name of Sexto erson in Cha of Prem es Connie Goedert (please print) W Signature Pe 66—yr Title Superintendent DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) 012831 Receipt k IT Human remains of delivered on 1 , Pine Mew Cemetery Representing\the funeral home named on burial permit Official Funeral Directors Reg.or License# ' {,1 PARRY JR. NAME Robert Parry JR. Age: 94 Lot Owner: Mrs. Robert J. Parry Lot# New Kenesaw 12C -Sec. 27 Grave# 1 Case: Concrete Died: 1 2/1 4/2 0 2 0 Interred:1 2/1 8/2 0 2 0 Funeral Home: Regan Denny Stafford Fh Cemetery: Pine View Cemetery