Reardon, Francis X NEW YORK STATE DEPARTMENT OF HEALTH/
Bureau of Vital Records / Burial - Transit Permit
Name First Middle - Last
I Sex
Francis X Reardon
Date of Death Male
Age If Veteran of U.S.Armed Forces,
08/05/2022 80 Years War or Dates
Place of Death Hospital,Institution or
LU
Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
Q Manner of Death Natural Cause ❑Undetermined ❑Pending
iW x Accident Homicide Suicide
GV Circumstances Investigation
Medical Certifier Name Title
Came Miron PA
Address
319 Broadway,Fort Edward Town,New York 12828
Death Certificate Filed Town Of Fort Edward District Number Register Number
City,Town or Village 5755 58
Burial Date Cemetery,Crematory or Facility Name
® 08/10/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
nDonation ,
g❑Removal Date Place Removed
H and/or and/or Held
N Hold Address
0
O. Date Point of
CO❑Transportation
C by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Date Cemetery Address
El Reinterment
Permit Issued to Registration Number
Name of Funeral Home Regan&Denny Funeral Service 01444
Address
94 Saratoga Ave,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
2 Address
Q
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/05/2022 Registrar of Vital Statistics Aimee G 9bfakoney(Efectronica/TySigned)
(signature)
District Number 5755 Place Town Of Fort Edward
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z UJ
Date of Disposition Till I R Place of Disposition 7�
(address)
W
CC
(section) (lot number) ) (grave number)
Q Name of Sexton or Person in Charge of Premises dt s..
L Alt
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please print)
Signature l Title (174504)
DOH-1555(07/18)p 1 of 2
1 LC�.
Public Health Law Sec. 4145(2b)
1
i Receipt
1
Human remains of delivered on , 20
1
1
Pine View Cemetery Representing the funeral home named on burial permit
I Official Funeral Directors Reg. or License# 7 ,