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Thompson, Gary Francis NEW YORK STATE DEPARTMENT OF HEALTH # ' Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Gary Francis Thompson Male Date of Death Age If Veteran of U.S.Armed Forces, 02/11/2022 74 Years War or Dates Army ZPlace of Death Hospital,Institution or City,Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death ©Natural Cause 11 Accident Homicide ElSuicide Undetermined Pending U Circumstances Investigation 0ILI Medical Certifier Name Title David Cunningham MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 104 Burial Date Cemetery,Crematory or Facility Name 02/14/2022 Pine View Crematory ❑Entombment Address ]Cremation Queensbury,New York ❑Donation OZ Removal Date Place Removed and/or and/or Held H Hold Address 0 Date Point of W 1-1 Transportation 5 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 O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/14/2022 Registrar of Vital Statistics Megan Wolin(ECectronically 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 Date of Disposition 2Z Place of Disposition , tV4.vrt�- (address/ W W (section) (lot number)/- a (grave number) SName of Sexton or Person in Charge of remises 1.��``QQL .,Mti,(,bi Z (plcpse print/ �* W Signature �'l r- Title 11 L 1 � e g DOH-1555(07/18)p t of 2 I5 11 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#