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Stokes Jr., John A If 3 ; 1 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records - Name First Middle Last Sex John A Stokes Jr Male Date of Death Age If Veteran of U.S.Armed Forces, 03/29/2021 77 Years War or Dates ZPlace of Death Hospital,Institution or W City,Town or Village Kingsbury Town Street Address 20 Quarry Circle Way, Kingsbury Town, New York 12839 p Manner of Death ©Natural Cause Ei Accident 1=1 Homicide ❑Suicide Undetermined ❑Pending (Wj Circumstances Investigation WC1 Medical Certifier Name Title Agee!Gillani MD Address 100 Park St,Glens Falls, New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Kingsbury Town 5762 6 ElBurial Date Cemetery,Crematory or Facility Name 04/01/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York Donation Removal Date Place Removed and/or and/or Held N Hold Address 0 O. Date Point of (o ❑Transportation b by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment 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 a Address Ir W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/31/2021 Registrar of Vital Statistics Cynthia Barizn(ECectronica1tySigned) (signature) District Number 5762 Place Kingsbury Town, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition t'/IZ 171 Place of Disposition11.1 2 (address) W M OC (section) (lot number) (grave number) 0 tp Name of Sexton or Person in Charge Premises ` r1 i + ,-- �iw1 M41 Z (p/ea a print) W Signature Title ` �{�� DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 01.4 6 8 7 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#