Navatka, Larry J ith7Z
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Lany J.Navatka Male
Date of Death Age If Veteran of U.S.Armed Forces,
06/07/2022 65 Years Waror Dates Air Force
I— Place of Death Hospital,Institution or
z City,Town or Village Glens Falls Street Address Glens Falls Hospital
3 Manner of Death a Natural Cause DAccident El Homicide Suicide Undetermined ❑Pending
IIJ
0 Circumstances Investigation
W Medical Certifier Name Title
0 Matthew Loftus PA
Address
100 Park St,Glens Fails,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
Cit ,Town or Village 5601 306
Burial Date Cemetery,Crematory or Facility Name
OB/09/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Don ation
0 Removal Date Place Removed
F and/or and/or Held
CA Hold Address
0
d. Date Point of
f/)❑Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
O
Re interment
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
S Address
CC
Ui
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/09/2022 Registrar of Vital Statistics Alvan Nan(7.4amracaa31Signtd)
(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:
W Date of Disposition (p 11012L Place of Disposition r,av� � -o rp
2 (address)
W
CO
CC (section) (lot number) (grave number)
gName of Sexton or Person in Charge of P emises , 64 `- tivo.tet
z / amprint/
W Signature Title 4 P rate
DOH 1555(07/18)p 1 of 2
1. 577q
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# -