Ryan, Thomas Floyd . r, _ 13
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Thomas Floyd Ryan Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/18/2020 71 Years War or Dates Navy
Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
0 Manner of Death g Natural Cause 1=I Accident El Homicide Suicide 0 Undetermined 0 Pending
IJJ
0 Circumstances Investigation
WW Medical Certifier Name Title
William Cleaver MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 583
❑Burial Date Cemetery,Crematory or Facility Name
12/21/2020 Pine View Crematory
D Entombment Address
EiCremation Queensbury,New York
❑Donation
ORemoval Date Place Removed
H and/or and/or Held
y Hold Address
to❑Transportation
Date Point of
a by Common Shipment
Carrier Destination
ElDisinterment Date Cemetery Address
Date Cemetery Address
El Reinterment
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
1.. Remains are Shipped,If Other than Above
2 Address
it
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/21/2020 Registrar of Vital Statistics ,o6ert,'tt1rewCnrtzr(Ekctronica1ySigned)
(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:
Date of Disposition /Z 23-74 te) Place of Disposition F,he.„Ur'Z'y4) Gr_o__,viev
2 (gddress)
W
I (section) J (tot number) (grave number)
:::::: °'
or Person i arge o remises fJ�Title 6c rh.w7DIy d o/clh"
DOH-1555(o7/i8)p 1 of 2
Public Health Law Sec. 4145(2b) #a 0 .� 1 8
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#