Ridley, Stephen Paul it in
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Stephen Paul Ridley Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/05/2021 59 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death 1771
Natural Cause Accident Homicide ❑Suicide El Undetermined El Pending
U Circumstances Investigation
W Medical Certifier Name Title
Gamal Khalifa MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 82
❑Burial Date Cemetery,Crematory or Facility Name
02/08/2021 Pine View Crematory
ElEntombment Address
X❑Cremation Queensbury Town,New York
ElDonation
O• ElRemoval Date Place Removed
and/or and/or Held
F- Hold Address
0
Date Point of
t/3u Transportation
by Common Shipment
Carrier Destination
❑Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
N Address
C
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/08/2021 Registrar of Vital Statistics Rp6ertJJnurrew Curtis g ctranica(Signed)
(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 Z(ej !24 Place of Disposition ,r7 G ---
W ( lfress)
W
N (section) (lot umber) (grave number)
0 0 , 4if
Name of Sexton or Person in Charge of Premises ti' n
Z please pi, t)
W Signature (—� Title t� �
DOH-1555(07/18)pi of 2
Public Health Law Sec. 4145(2b) 01451
Receipt 1
Human remains of delivered on , 20
/
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# 1