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Russell, Earl Wade 7 • f `# li NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Earl Wade Russell Male Date of Death Age If Veteran of U.S.Armed Forces, 12/24/2021 61 Years War or Dates 1,_ Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death ©Natural Cause ❑Accident El Homicide ❑Suicide ❑Undetermined El Pending W Circumstances Investigation W Medical Certifier Name Title CI Sean Bain MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 636 ❑Burial Date Cemetery,Crematory or Facility Name 01/04/2022 Pine View Cemetery ❑X Entombment Address ❑Cremation Queensbury Town,New York ElDonation g 0 Removal Date Place Removed and/or and/or Held — Hold Address VI 2 Date Point of to ❑Transportation Shipment a by Common Carrier Destination Date Cemetery Address ElDisinterment 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 F.. Remains are Shipped,If Other than Above 2 Address MC W CI' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/29/2021 Registrar of Vital Statistics 106ertAndrew Curtis(E(ectronica(ty 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: //��u WDate of Disposition /`5.2 2 Place of Disposition 2/ o.{Q,,t,,4.i eo4� ().\itti_ga46-fay . id / /,2 W 2 (address) Q (section /� (lot number) (grave number) 8 Name of Sexton erson in Charge of Premises L'0 mute / 4) ;" Z (pleas tint) IliLje_i___„/Q Signature fi/La 12o(�-�'l`�/ Title dikee DA 2.lA U DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 012893 Receipt i • _ Human remains of ' ) , _ delivered on , 20 22 ?Pine View Cemetery Representing the funeral home named on burial permit ( Official - Funeral Directors Reg.or License# RUSSELL ;S 1 NAME 61 Earl Wade Russell Age: Lot Owner: Wade & Carol Russell Lot# Adirondack # 8 Grave# 2Bottom Case: Mausoleum Died: 12.24 .21 . Interred:1 .5.2 2 Funeral Home: Regan Denny Stafford Cemetery: pine View