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McIntosh, Gary Richard • - 5-2 NEW NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Gary Richard McIntosh Male Date of Death Age If Veteran of U.S.Armed Forces, 03/05/2021 67 Years War or Dates i.. Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 18 Farr Lane Lane Apt 109,Queensbury Town,New York 12804 p Manner of Death © Natural Cause 1=1 Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending W Circumstances Investigation QMedical Certifier Name Title Lisa Greenwald NP Address 2 Irongate Plaza,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 64 ❑Burial Date Cemetery,Crematory or Facility Name 03/09/2021 Pine View Crematory ❑Entombment Address iCremation Queensbury Town,New York ❑Donation IS ❑Removal Date Place Removed and/or and/or Held pN Hold Address O CL Date Point of N ❑Transportation 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 Remains are Shipped,If Other than Above 2 Address Cr W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/09/2021 Registrar of Vital Statistics Carofine?fiCfegarieBarber(ECectronica(CySigned) (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: Z W Date of Disposition 3/ej Z) Place of Disposition (,, (ddres/s) ILI N (section) ((IIQE number) (grave number) QName of Sexton or Person in Charge of Pre i es (/1�' ��'"` K' Z (please pint) W Signature Title 6 ►it Mt DOH-1555(07/18)p 1 of 2 r _ Public Health Law Sec. 4145(2b) 0 14 61 c Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#