DePoy,Christopher Bartley .." tt 23y
NEW YORK STATE DEPARTMENT OF HEALTH t44t ‘ Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
• Christopher Bartley DePoy Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/27/2021 66 Years
t,T War or Dates
1 Place of Death Hospital,Institution or
City,Town or Village Moreau Town Street Address 11 Grey Fox Drive, Moreau Town,New York 12828
Manner of Death xi Natural Cause ID Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
John Pezzulo DO
Address
g2.
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Moreau 4562 14
L.jr1 Burial Date Cemetery,Crematory or Facility Name
03/02/2021 Pine View Crematory
❑Entombment Address
am Cremation Queensbury Town,New York
4, ❑Donation
ZRemoval Date Place Removed
and/or and/or Held
Hold Address
1,00
Transportation Date Point of
IMMO
Q by Common Shipment
.H Carrier Destination
V - Disinterment Date Cemetery Address
-Reinterment Date Cemetery Address
, Li'' Permit Issued to Registration Number
• Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
Address
i^ 136 Main St,S Glens Falls,New York 12803
' Name of Funeral Firm Making Disposition or to Whom
r.
Remains are Shipped,If Other than Above
Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
• Date Issued 03/02/2021 Registrar of Vital Statistics Geeann Mc ca6e(EfectronicalrySigned)
(signature)
District Number 4562 Place Moreau, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date ofDisposition 3 3 Z Place of Disposition ,
111
1 I IL �„ f�r�,--
2 (address)
Ui
CC N (section) (lot number) (grave number)
Q
Name of Sexton or Person in Charge of Prem. s AA 1 c c"v4411
j (p se print)
, Signature Title (W'111i14
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of ,�, delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#