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McQuain, Earl Stephen
)1 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records ka' Name First Middle Last Sex Earl Stephen McQuain Male Date of Death Age If Veteran of U.S.Armed Forces, 01/05/2022 58 Years War or Dates Marines H Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 1581 Bay Road,Queensbury Town,New York 12804 `p Manner of Death ©Natural Cause ❑Accident Homicide ❑Suicide ❑Undetermined ❑Pending U Circumstances Investigation GMedical 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 3 ❑Burial Date Cemetery,Crematory or Facility Name 01/07/2022 Pine View Crematory ❑Entombment Address Cremation Queensbury,New York Donation OZ El Removal Date Place Removed and/or and/or Held H Hold Address 0 tall ❑Transportation Date Point of ES 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 I— Remains are Shipped,If Other than Above 5 Address Q W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/07/2022 Registrar of Vital Statistics Caroline x&fegarde Barber(ECectronica1ty Signed) (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: I— Z Date of Disposition /—f^ Z 2 Place of Disposition ?, e v j y e,yt a;tdrI 2 (address) W CCC D (section) (lot umber) (grave number) 8 Name of Sexton or Person in rge of P emises J Li (/ 1 rl'‘ 6,a.vrt e-ve (please print) W Signature ` Title G:re my dP�w�� DOH-1555(07/18)p 1 of 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#