Andrews, Bernard William NEWYORKSTATEDEPARTMENTOFHEALTH Bu
rial of Vital Records - Transit Permit
Name First Middle Last Sex
Bernard William Andrews Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/17/2022 85 Years War or Dates
i.. Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address 10 Spring Street,Glens Falls,New York 12801
Manner of Death 1771
Natural Cause Accident El Homicide Suicide ❑Undetermined Pending
W C.) Circumstances Investigation
Ili
Medical Certifier Name Title
Mary Stein NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 118
ElBurial Date Cemetery,Crematory or Facility Name
02/19/2022 Pine View Crematory
Entombment Address
gCremation Queensbury Town,New York
ElDonation
Removal Date Place Removed
and/or and/or Held
N Hold Address
0
O. Date Point of
N ❑Transportation
p 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
i— Remains are Shipped,If Other than Above
Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/18/2022 Registrar of Vital Statistics Zoe Morgan(!Yectronica/ySrgned
(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 Place of Disposition 6,1 a `2 i
W /
2 (address)
W
CC (section) (lot tuber) (grave number)
0 Name of Sexton or Person in Ch e o Pr lees JC r1�/7/dv►tD�
Z (please print/
W Signature Title v�� 7�1
DOH-1555(07/18)p 1 of 2
"ji r 1 5, y
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#