Girard, Michael Anthony 10F, s3k
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Michael Anthony Girard Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/04/2022 75 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address 54 Mason Street,Glens Falls,New York 12801
p▪ Manner of Death E1 Natural Cause Accident ❑Homicide OSuicide Undetermined El Pending
✓ Circumstances Investigation
W Medical Certifier Name Title
O Paul Filion MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 351
Burial Date Cemetery,Crematory or Facility Name
07/06/2022 Pine View Crematory
Entombment Address
OCremation Queensbury,New York
DDonation
0Z❑Removal Date Place Removed
and/or and/or Held
N Hold Address
0
O. Date Point of
N Transportation Shipment
by Common
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
a Reinterment
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
▪ Remains are Shipped,If Other than Above
71 Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/05/2022 Registrar of Vital Statistics Megan Noftn(E(ectronicaIySigned)
(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:
WDate of Disposition -I J$(Z Z Place of Disposition XI 4%Jt-. 4114 __..
2 (address)
W
Q (section) /J (lot number) smvi (grave number)
tt
G Name of Sexton or Person in Charge of Premises [%//�M1`
/ 'ease print)
W Signature L/� '�� Title
DOH-1555(o7/18)p t of 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#