Threw, Richard W NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Richard W Threw Male
Date of Death Age If Veteran of U.S.Armed Forces,
05/25/2022 83 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
WW Manner of Death
El Natural Cause Accident Homicide OSuicide Undetermined ri Pending
U Circumstances Investigation
GMedical Certifier Name Title
Gamal Khalifa 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 292
X Burial Date Cemetery,Crematory or Facility Name
05/31/2022 Pine View Cemetery
Entombment Address
Cremation Queensbury Town,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
f- Hold Address
O
O. Date Point of
N OTransportation
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
1— Remains are Shipped,If Other than Above
2 Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/31/2022 Registrar of Vital Statistics Megan.Wolin(E(ectronica1lySigned)
(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:
Z Date of Disposition j. I• a a Place of Disposition cQ/ UQ /{� /-6 - Q l�ec.f)S c1 t �( iv / /a)az
W
(address)
w 1d66),-, 3 LI-
Q (section (lot number) (grave number)
aName of Sexton or Person in Charge of Premises r)/J!C GUc,(--k2-71-
(please prin h tt)
IlJ Signature "� ,J Title :1 r r i 1�e"-?Ci
DOH-1555 l07/18)p 1 of 2
I
• Public Health Law Sec. 4145(2b) 012921
Receipt
1 --,
1 Human remains of I`` (_:-r - delivered on ' ' ` r , 20 ,
me View Cemetery Representing the funeral home named on burial permit
. Official Funeral Directors Reg.or License#
THREW —617Xi</14,.14
William Threw, Richard Threw,&Donald Stockman Lot No. 34
Address Luzerne Road, RD#3, Glens Falls, N.Y. Section No. 3
Owner William Threw, Richard Threw & Donald Stockman PlotNew Hudson
7ounc01-k
Date May 9, 1968
400 Superficial ft. @ $1 .50 per Sq.Ft.
Location bounded North, East, South and West by grass paths. South by lots of
King and Frasier
Corner Posts
Remarks
Deed No. (and changes) 11047
Payment Record May 9, 1968 Paid in Full
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Form No. 01 Nei "Y
Record of Interments ,�7
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EaNward W. Threw 5--/-1-a-
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• Rosemary W . Threw j 1 ni 6 ‘l eD l� l hr 3 5.31 a
Elizabeth Threw 10/14/03 / 1 7 i�r.
W Threw 5-?-G ✓ 8 II
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THREW
NAME Richard W Threw Age: 83
Lot Owner: William & Richard Threw
and Donald Stockman
Lot# Hudson #3 34 Grave# 6
Case: Concrete
Died: 5.2 5.2 2 Interred:5.31 .2 2
Funeral Home: Regan Denny Staf ford
Cemetery: Pine View