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Creveling, Neil Robert i it 1 18/ NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Neil Robert Creveling Male Date of Death Age If Veteran of U.S.Armed Forces, 02/26/2022 28 Years War or Dates Place of Death Hospital,Institution or City,Town or Village Lake George Town Street Address 31 Old Lake Road, Lake George Town, New York 12845 Manner of Death ❑Natural Cause ❑Accident E Homicide ❑Suicide Undetermined ©Pending UCircumstances Investigation Medical Certifier Name Title Connie Goedert Coroner I Address 1400 St Route 9,Lake George Town,New York 12845 Death Certificate Filed District Number Register Number City,Town or Village Lake George 5651 ❑Burial Date Cemetery,Crematory or Facility Name 03/02/2022 Pine View Crematory 0 Entombment Address ElCremation Queensbury,New York ❑Donation Z ❑Removal Date Place Removed pand/or and/or Held 1 Hold Address tH❑Transportation Date Point of 5 by Common Shipment Carrier Destination El 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 2 Remains are Shipped,If Other than Above Address 1 Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/01/2022 Registrar of Vital Statistics Patricia ,Mc7(inney-Schuster(ECectronica1tySigned) (signature) District Number 5651 Place Lake George, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 3/Z 127 Place of Disposition 4.7t Vs— 4 n, 2 (address) W iE (section) (l number) (grave number) 8 Name of Sexton or Person in Charge of P ises /nb L ilt / (please p int) iLl641110174. Signature (/\ Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) FC¢ Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#