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Emiger, Kenneth R ,t it NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kenneth R Ermiger Male Date of Death Age If Veteran of U.S.Armed Forces, 10/25/2021 . 83 Years War or Dates f,. Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death © Natural Cause 0 Accident ❑Homicide 0 Suicide ❑Undetermined El Pending W v Circumstances Investigation W Medical Certifier Name Title G Christopher Smith MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 461 ElBurial Date Cemetery,Crematory or Facility Name 10/27/2021 Pine View Crematory ElEntombment Address X❑Cremation Queensbury Town,New York ElDonation Z ❑Removal Date Place Removed and/or and/or Held pQN Hold Address a Date Point of V! Li 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 Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom F. Remains are Shipped,If Other than Above 2 Address fr W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/27/2021 Registrar of Vital Statistics Wpbert Andrew Curtis(ECectronicafly Signed) (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 .,�� 1 � W Date of Disposition 10 114 Place of Disposition i 2 (address) LU NCC (sectbn) A (lot number) c (grave number) 0 Name of Sexton or Person in Charge of Premisesi'L} ,�'� ��44, W li (pi a print) Signature Title 6( DOH-1555(07/18)p 1 of 2 I - .)i c9i 0 Public Health Law Sec. 4145(2b) Receipt Human remains of , , delivered on , 20 f Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#