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Ward, Eugene Albert 3I LiNEW YO R K STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit t Name First Middle Last Sex Eugene Albert Ward Male Date of Death Age If Veteran of U.S.Armed Forces, 03/27/2021 52 Years War or Dates 1,. Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending V Circumstances Investigation EMedical Certifier Name Title Asim Chaudry MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 161 ❑Burial Date Cemetery,Crematory or Facility Name 03/30/2021 Pine View Crematory ❑Entombment Address 11 Cremation Queensbury,New York ❑Donation ❑Removal Date Place Removed H and/or and/or Held Hold Address 0 P. Date Point of U) ❑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 F. Remains are Shipped,If Other than Above IAddress Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/30/2021 Registrar of Vital Statistics `&6ertAndrew Curtis(ECectronicalrySigned) (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 3/31 171 Place of Disposition `/—i IL L - ILIl (address) W (section) tot number) (grave number) 8 Name of Sexton or Person in C arge of Premises `I.-+ .S>M4Lt Z (p/easgp w rint) YJ Signature L/ Title C il' A` g WIVVI DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0.14 682 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# 4