Mannion, Brian C LjII NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Brian C Mannion Male
Date of Death Age If Veteran of U.S.Armed Forces,
05/10/2021 78 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town.or Village Glens Falls Street Address Glens Falls Hospital
W• Manner of Death Undetermined Pending
Natural Cause 1=1Accident Homicide Suicide
W C.) Circumstances Investigation
W Medical Certifier Name Title
O Gamal Khalifa MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 208
0 Burial Date Cemetery,Crematory or Facility Name
05/12/2021 Pine View Crematory
0 Entombment Address
lCremation Queensbury Town,New York
Ej Donation
Removal Date Place Removed
and/or and/or Held
N
Hold Address
0
Date Point of
q) Li Transportation Shipment
b by Common
Carrier Destination
Ei 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
1— Remains are Shipped,If Other than Above
2 Address
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/11/2021 Registrar of Vital Statistics Men Andrew Curtis(EfectronicaffySigned)
(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:
Z Date of Disposition S I)3 I I/ Place of Disposition 4JL �vc%--
W (address)
W
CC (section) ipt number/ (grave number)
Name of Sexton or Person in Charge of Pre 'ses r, `.5;14/% 0'
(please pd%nt)
W Title ��'r,"���
Signature
DOH-1555(o7/18)p t of 2
Public Health Law Sec. 4145(2b) 014.7-el 9
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#