Hafner, Gunther Joseph y i
'. , 31
NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Gunther Joseph Hafner Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/11/2022 82 Years War or Dates Navy
1.,: Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address Glens Falls Hospital
Oita Manner of Death ❑X Natural Cause Accident Homicide lilSuicide Undetermined Pending
UCircumstances Investigation
Medical Certifier Name Title
Christopher Smith MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 157
'Burial Date Cemetery,Crematory or Facility Name
03/12/2022 Pine View Crematory
Entombment— Address
'aCremation Queensbury,New York
r., Donation
QnRemoval Date Place Removed
and/or and/or Held
H Hold Address
O
0. Date r,,, , Point of
CO IllTransportation
G by Common Shipment
Carrier Destination
❑Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
i
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
2 Address
re
Q' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/11/2022 Registrar of Vital Statistics Megan Wolin(ECectronicalrySigned)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
f
WDate of Disposition 3-/2-zoZZ Place of Disposition ') �)a 0:-P.r,�) G,Piiym,)4
2 (address)
IW
CCCC (section) (lotJoor(
umber) (grave number)
J\ A
8 Name of Sexton or Person in Charge of Premises ymuN bt
o
Z (p/ease print)
-
W Signature Title r � �
DOH-1555(07/18)p 1 of 2
r }
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#'.
ii Z33
NEW YORK STATE DEPARTMENT OF HEALTH `
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Ida Paula Cunningham Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/11/2022 82 Years War or Dates
.j;. Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address Glens Falls Hospital
id Manner of Death El Natural Cause Accident E Homicide OSuicide Undetermined Pending
UCircumstances Investigation
EMedical Certifier Name Title
William Cleaver MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 160
Burial Date Cemetery,Crematory or Facility Name
03/14/2022 Pine View Crematory
Entombment Address
'; aCremation Queensbury,New York
a❑Donation
8 E Removal Date Place Removed
and/or and/or Held
N Hold Address
Transportation
Date Point of
el by Common Shipment
Carrier Destination
Date Cemetery Address
a❑Disinterment
Date Cemetery Address
❑Reinterment
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
j Remains are Shipped,If Other than Above
s Address
5
Q' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/14/2022 Registrar of Vital Statistics !Megan No fin(ECectronicallySigned)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 31I4 I2Z Place of Disposition 474,: /tOrs„....._
ILU
2 (address)
W
y
LC (section) 4 , (lot.number) (grave number)
O Name of Sexton or Person in Charge of P mises n b St%14 i1(r
z / ase print) r
IL Signature v'— Title ( �
DOH-1555(07/18)p 1 of 2
'p 1 . 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