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Truesdale, Gilbert # g.7 NEW YORK STATE DEPARTMENT OF HEALTH W Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Gilbert Truesdale Male Date of Death Age If Veteran of U.S.Armed Forces, 01/27/2022 95 Years War or Dates F,. Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Town Street Address 325 Broadway Apt 5,Fort Edward Town,New York 12828 `p Manner of Death ©Natural Cause 0 Accident El Homicide ❑Suicide Undetermined Pending U Circumstances Investigation C Medical Certifier Name Title Gerard Abess MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 8 ❑Burial Date Cemetery,Crematory or Facility Name 01/28/2022 Pine View Crematory ❑Entombment Address O Cremation Queensbury,New York ❑Donation Z Date Place Removed a❑Removal and/or and/or Held IAHold Address (t 1=1 Transportation Date Point of 5 by Common Shipment Carrier Destination 1❑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 lx W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/27/2022 Registrar of Vital Statistics Aimee G 9Kakoney(E(ectronicaffy Signed) (signature) District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition ' /rg IZZ Place of Disposition Fe v. ,_ 6jt;,_ 2 (address) W CC N (section) (lot number) (grave number) /A 8 Name of Sexton or Person in Charge of Premises �t°l �►'►4 ft Z / lease print) W Signature ip L Title *Ail RAZ DOH-1555(07/18)p 1 of 2 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#