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Eggleston, Edgar # 5-p NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Edgar Eggleston Male Date of Death Age If Veteran of U.S.Armed Forces, 01/08/2022 77 Years War or Dates 1980-1984 Place of Death Hospital,Institution or Z City,Town or Village Albany Street Address Albany Medical Center Hospital UJ Ip Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation WC Medical Certifier Name Title Jacqueline Sayres PA Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 0072 ❑Burial Date Cemetery,Crematory or Facility Name 01/14/2022 Pine View Crematory Entombment Address X❑Cremation Queensbury Town,New York ❑Donation gRemoval Date Place Removed and/or and/or Held ~ Hold Address 0 O. Date Point of W Li Transportation a 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 }.. Remains are Shipped,If Other than Above 2 Address W 0. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/11/2022 Registrar of Vital Statistics DanielleSGillespie(E(ectronical(ySigned) /signature/ District Number 0101 Place Albany, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition p f`j 127— Place of Disposition --es4t (address) W CC N /sedan/ (lot number) (grave number) 8 Name of Sexton or Person in Charge of Premises arTi (p4ase print/ f„�tr W Signature Title ( 'AM. DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) 1 '`� `" Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on'burial permit Official Funeral Directors Reg.or License# Town of Queensbury 01111 Certification of Cremation s0_� Pine View Cemetery and Crematory This certifies that the remains of: Edgar Eggleston were cremated on January , 15 20 22 at the Pine View (Month) (Day) Crematorium, Queensbury,New York, and these are the cremated remains of said body. Date of Death January , 8 20 22 Age 77 (Month) (Day) Funeral Home Regan Denny Stafford Registered No. 50 xjy, (Authorized Signature) EGGLESTON LE NAME Edgar Eggleston Age: 77 Lot Owner: Edgar & Sue Eggleston Lot# Erie 13 A Grave# 2 Case: Urn Died: 1 . 1 5.2 2 Interred: 9. 1 7 .2 2 Funeral Home:Regan Denny Stafford Cemetery: Pine View EGGLESTON Lot No. 13A Address 180 AA Deakins Road Jonesborough nn. 37659 Section No. ERIE Owner Edgar & Sue Eggleston LF Plot FajOdciAl Date 7/7/2014 Superficial ft. @ 67 Location Bounded on East Vacant, Bounded south by path, bounded west vacant bounded nn Nnrth vacant Corner Posts Remarks Deed No. (and changes) 3_8 5.11 Payment Record Paid in full $1200. Queensbury residences Record of Interments _ c. ks 9 111) £ 4 U d rj - ..- — ,1 FJ Form No. 01