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Garlick, Paul William
#3/r NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Paul William Garlick Male Date of Death Age If Veteran of U.S.Armed Forces, 05/03/2021 66 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village South Glens Falls Village Street Address Midtown Apartments Riverview Street 231 A,South Glens Falls Village,New York 12803 CI © NW Manner of Death atural Cause 1=1 Accident El Homicide El Suicide El Undetermined El Pending W C.) Circumstances Investigation W Medical Certifier Name Title CI Christopher Hoy MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village South Glens Falls Village 4524 12 Burial Date Cemetery,Crematory or Facility Name 05/05/2021 Pine View Crematory ❑Entombment Address 0 Cremation Queensbury Town,New York Donation Z El Removal Date Place Removed and/or and/or Held N Hold Address 0 1-1 Date Point of U) ❑Transportation Shipment B by Common — Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan&Denny Funeral Service 01444 Address 94 Saratoga Ave,S Glens Falls,New York 12804 Name of Funeral Firm Making Disposition or to Whom F Remains are Shipped,If Other than Above 5 Address CC W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/04/2021 Registrar of Vital Statistics Shannon?(etCeher(ECectronicallySigned) (signature) District Number 4524 Place South Glens Falls Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition S I S 1,I Place of Disposition 4I4L. 71 2 (address) ILl . CC (section/ (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises �T 1 _ SMwA t? Z / (pleas r 1 eYvint) LU Title (6:40iiytt Signature DOH-1555(07/18)pi of 2 1 Public Health Law Sec. 4145(2b) /1 Receipt 1 Human remains of delivered on , 20 1 1 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#