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Demirov, Victor I
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Victor I Demirov Male Date of Death Age If Veteran of U.S.Armed Forces, 01/04/2022 71 Years War or Dates i— Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital WManner of Death ©Natural Cause El Accident ❑Homicide ElSuicide 0 Undetermined ❑Pending 0 Circumstances Investigation W Medical Certifier Name Title CI William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 4 ©Burial Date Cemetery,Crematory or Facility Name 01/07/2022 Pine View Cemetery ElEntombment Address ElCremation Queensbury Town,New York ElDonation Z El Removal Date Place Removed and/or and/or Held t= o Hld Address fN U) U Transportation Date Point of S by Common Shipment 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 1— Remains are Shipped,If Other than Above 2 Address Q 11 Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/05/2022 Registrar of Vital Statistics Megan Wo1iin(ECectronica1Ty 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 W Date of Disposition 1. 1 O9c2. Place of Disposition o7( c LciJkC Rd Ct�� rr , iv �� / 0 f 2 (address) / 1111 CC (section/ ) (lot number) (grave number) gName of Sexton or Person in Charge of Premises / nn/< moo"c4C4 Z (please print) laSignature • Title g')(..A as 4C,789-.t2 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 012895 Receipt Human remains of V r.`. r 1 r' delivered on f , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# Demirov NAME Victor I Demirov Age: 71 Lot Owner: Victor I Demirov Lot# Erie 5E Grave# 1 Case: Concrete Died: 1 .4.2 2 Interred: 1 . 7.2 2 Funeral Home: Regan Denny Stafford Cemetery: Pine View