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Oakley, Thomas 41- i i . NEW YORK STATE DEPARTMENT OF HEALTH " B Burial - Transit Permit ureau of Vital Records Name First Middle Last Sex Thomas Oakley Male Date of Death Age If Veteran of U.S.Armed Forces, 12/24/2021 64 Years War or Dates l,.. Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 35 Evergreen Lane 123,Queensbury Town,New York 12804 0 Manner of Death © Natural Cause 0 Accident ❑Homicide 0 Suicide 0 Undetermined ❑Pending ILI 0 Circumstances Investigation WC Medical Certifier Name Title Timothy Murphy Coroner Address 52 Haviland Avenue,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 256 ElBurial Date Cemetery,Crematory or Facility Name 01/03/2022 Pine View Crematory 0 Entombment Address ElCremation Queensbury Town,New York ❑Donation Z❑Removal Date Place Removed }, and/or and/or Held N Hold Address 0 O. Date Point of N ❑Transportation 3 by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address 11 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 l . Remains are Shipped,If Other than Above 3 Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/31/2021 Registrar of Vital Statistics Caroline Wiffegarde Barber(E(ectronicaltySigned) (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: Date of Disposition (/li 177, Place of Disposition _,-F emu)` �✓1 ps�. IU 2 /address) W N CC (section) //otnumber) c (grave number) 8 Name of Sexton or Person in Charge of Premises7 �\(i. `. ,�v� tt z /ease print) uJ Signature Title �in 10 V DOH-1555(07/18)p 1 of 2 915503 Public Health Law Sec. 4145(2b) Receipt Human remains of ` f .` delivered on , 20 =',7 1 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#