Steiner, Francis H. NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Francis H.Steiner Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/14/2021 86 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death ❑X Natural Cause ❑Accident Homicide El Suicide El Undetermined 1=1 Pending
W Circumstances Investigation
W Medical 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 179
Burial Date Cemetery,Crematory or Facility Name
04/16/2021 Pine View Crematory
Entombment Address
0 Cremation Queensbury Town,New York
Donation
Z Removal Date Place Removed
and/or and/or Held
N Hold Address
0
Date Point of
(/) Li Transportation Shipment
Q by Common
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
Reinterment
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
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/15/2021 Registrar of Vital Statistics 4Rp6enf?tuIrewCurtir(EkctranrcatYSWne4
(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:
I-
Z Date of Disposition Place of Disposition
W (address)
W
Cr (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises (please print)
W Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 014722
Receipt
#
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#