Martin, Wesley A Town of Queensbury
Certification of Cremation
Pine View Cemetery and Crematory
This certifies that the remains of: Wesley A. Martin
were cremated on January 23 20 21 at the Pine View
(Month) (Day)
Crematorium, Queensbury, New York, and these are the cremated remains of said body.
Date of Death January 16 20 21 Age 93
(Month) (Day)
Funeral Home Regan,Denny,Stafford Funeral Home Registered No. 65
2./k',/,refhze/
(Authorized Signature)
Martin
NAME Wesley A. Martin Age: 93
Lot Owner:Wesley & Margaret Martin
Lot# Mohican 2 E Grave# 1
Case:
Urn
Died: 1 /1 6/2 0 21 Interred4/1 6/2 0 21
Funeral Home: Regan Denny Stafford
Cemetery: Pine View
NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Wesley A.Martin Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/16/2021 93 Years War or Dates Navy
Place of Death Hospital,Institution or
W City,Town or Village Queensbury Town Street Address 2 Owen Avenue,Queensbury Town, New York 12804
O Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined ❑Pending
W(3 Circumstances Investigation
W Medical Certifier Name Title
G Alexandra Aarons MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 18
❑Burial Date Cemetery,Crematory or Facility Name
01/19/2021 Pine View Crematory
Entombment Address
]Cremation Queensbury,New York
Donation
Z Removal Date Place Removed
and/or and/or Held
Hold Address
0
0• Date Point of
M Li 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
" Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/19/2021 Registrar of Vital Statistics Carolinexkkgarrle Bader((YectronicatySigned/
(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:
W
Date of Disposition / 3 2V2 f Place of Disposition 0aA Lr e) C k.J
2 (address)
W
N (section) f` (lot number) (grave number)
O Name of Sexton or Person in Cha of Premi es 1 ) i??�eJ 0 J=
(please print)
W Signature I; Title (� e
DOH-1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2b) 014431
Receipt
Human remains of delivered on , 20
d - .
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#