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Palmer, Raymond J., Sr. NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Raymond J Palmer Sr Male Date of Death Age If Veteran of U.S.Armed Forces, 10/02/2021 95 Years War or Dates 1944-1946 i_ Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address Glens Falls Center for Rehabilitation and Nursing UJ p Manner of Death © Natural Cause ElAccident ElHomicide I:Suicide ❑Undetermined El Pending Circumstances Investigation W Medical Certifier Name Title C3 Wendy Steinhacker PA Address 152 Sherman Ave,Queensbury Town,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 204 ©Burial Date Cemetery,Crematory or Facility Name 10/05/2021 Pine View Cemetery Entombment Address Cremation Queensbury Town,New York ElDonation Z Removal Date Place Removed and/or and/or Held F. Hold Address N N ❑Transportation Date Point of S by Common Shipment Carrier Destination El 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 1— Remains are Shipped,If Other than Above 2 Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/04/2021 Registrar of Vital Statistics Caroline x1tlegarde Barber(ECectronica1Cy Signed) (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: Z W Date of Disposition %,s. aPlace of Disposition 0L►c►\{c fZ Q() LJU« Kti (13RQ4 2 (address) w i.c>Cii-1 iE!) ac (section ) (tot number) (grave number) SName of Sexton or Person in Charge of Premises G n*1 i 4 _}—t Z (please print) UJ Signature Title Jv; in- _,i'\ � DOH-1555(07/18)p i of 2 Public Health Law Sec. 4145(2b) u 1 2 8 7 5 Receipt • Human remains of--1---\,0A \A 1:iv\e'r" , 20 2 delivered Pin t e View C emewy Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# PALMER NAME Raymond J Palmer Sr. Age: 95 Lot Owner:Raymond J & Sylvia R Palmer Sr Lot# Horicon 3B Grave# 1 Case: Concrete Died: 1 0 .2.21 . Interred: 1 0.5.21 Funeral Home: Regan Denny Stafford Cemetery:Pine View