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Greenfarb, Louis 5-10 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Louis Greenfarb Male Date of Death Age If Veteran of U.S.Armed Forces, 07/08/2021 73 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Lake George Village Street Address 3 Old Post Road,Lake George Village,New York 12845-0791 Manner of Death Undetermined 1=1Pending � ©Natural Cause �Accident �Homicide �Suicide W C.) Circumstances Investigation W Medical Certifier Name Title Paul Byron MD Address 719 County Route 60,Greenwich Town,New York 12834 Death Certificate Filed District Number Register Number City,Town or Village Lake George Village 5620 3 ❑Burial Date Cemetery,Crematory or Facility Name 07/09/2021 Pine View Crematory ❑Entombment Address Cremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held ~ Hold Address 0 4. Date Point of (I) Li Transportation Shipment B by Common Carrier Destination Disinterment Date Cemetery Address El 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 �.. Remains are Shipped,If Other than Above a Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/09/2021 Registrar of Vital Statistics (Debra 9 YfrIckinney(Electronicafty Signed) (signature) District Number 5620 Place Lake George Village, 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 '7-4-.20.21 Place of Disposition P; d,,,.) eret.tst+I,(� 2 (address) ILI Cl) (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premi sa/ 6L ,/ (please print) W Signatur /y Title 0�'e_ 2t40, DOH-1555(o7/t8)p t of 2 Public Health Law Sec. 4145(2b) 014930 Receipt 1 Human remains of _ delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#