Vadnais, Paul D LF itt
y
NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Paul D Vadnais Male
Date of Death Age If Veteran of U.S.Armed Forces,
013/01/2022 89 Years Waror Dates
Place of Death Hospital,Institution or
ZW City,lown or Village Glens Falls Street Address Glens Falls Hospital
G Manner of Death El Natural Cause Accident 0 Homicide OSuicide ❑Undetermined ❑Pending
W Circumstances Investigation
W Medical Certifier Name Title
G Asim Chaudry MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
Cit ,Town or VillageEi
5601 297
Burial Date Cemetery,Crematory or Facility Namery Addre2022 Pine View Cremato
Entombment Address
IICremation Queensbury Town,New York
Donation
SORemoval Date Place Removed
and/or and/or Held
NHold Address
n
tTransportation Date Point of
Q by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
dReinterment
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
IH Remains are Shipped,If Otherthan Above
2 Address
Q
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/02/2022 Registrar of Vita l Statistics Nsgan.Xo!itr(EYsctmmcaQ Sigtr4
(signature/
District Number 5801 Place City Of Glens Fad
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition (p 13 ZZ Place of Disposition p,,�.(� L"(b.- _
2 iatddress)
W
CC (section) (lot number) (gra re number)
2 f i..� S`hivi t .
Name of Sexton or Person in Charge of Pre ' es
(pie print)
W Signature —Z. Title
r W7K
DOH 1555(07/18)p 1 of 2
n • '7
p
Public Health Law Sec. 4145(2b)
Receipt
.
Human remains of delivered on , 20
•
Pine View Cemetery Representing the funeral home med pn,buriat,permit
Official Funeral Directors Reg.or License#