Loading...
Culver, Matthew J NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Matthew J Culver Male Date of Death Age If Veteran of US.Armed Forces, 12/12/2021 36 Years War or Dates 1.. Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address 7 Union Street Apt 3B,Glens Falls,New York 12801 p Manner of Death ©Natural Cause El Accident ❑Homicide I=1 Suicide 0 Undetermined 0 Pending W C.) Circumstances Investigation W Medical Certifier Name Title O William Parker MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 595 IDBurial Date Cemetery,Crematory or Facility Name 12/15/2021 Pineview Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ElDonation Z ❑Removal Date Place Removed and/or and/or Held ~ Hold Address fN 0 Date Point of VI ❑Transportation Shipment p by Common Carrier Destination Ei Disinterment Date Cemetery Address El Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom l— 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 12/14/2021 Registrar of Vital Statistics Robert Andrew Curtis(Electronically 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: l? Z Date of Disposition I ZIetili Place of Disposition �I,L [J�—� W (address) uJ N (section) (lot number) c (grave number) 0 1. it O Name of Sexton or Person in harge of Premises n� O `< /P ase print/ (MA Vra IllSignature _„` Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#