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Suckman, Henry A
, # go NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Henry A Suckman Male Date of Death Age If Veteran of U.S.Armed Forces, 02/27/2022 80 Years War or Dates Navy H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital WManner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide Undetermined Pending 0 Circumstances Investigation GMedical Certifier Name Title Mathew Varughese DO Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 129 ❑Burial Date Cemetery,Crematory or Facility Name 03/01/2022 Pine View Crematory ❑Entombment Address lCremation Queensbury,New York ❑Donation gRemoval Date Place Removed and/or and/or Held N Hold ',Address 0 O. Date Point of VI Li Transportation by Common Shipment Carrier Destination Disinterment 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 a Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/28/2022 Registrar of Vital Statistics Megan Wolin(E(ectronicallySigned) (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 /r _ 111 Date of Disposition 3/z�2Z Place of Disposition ,w� .�-drw� 2 (address) W Q (section) (lot number) (grave number) gName of Sexton or Person in Charge of remises ass „ ,�ytin4tf} Z (vase print) W L%1 Title f�16/A+1� C Signature DOH-1555(o7/18)p t of 2 "t 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#