Every, Richard y5
DI'.
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Richard Every Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/23✓2022 67 Years Waror Dates
F Place of Death Hospital,Institution or
ZW City,Town or Village Glens Falls Street Address 13 First Street,Glens Falls,New York 12801
O Mannerof Death a Natural Cause Accident El HomicideSuicide Undetermined ❑Pending
UJ
0 Circumstances Investigation
WMedical Certifier Name Title
G Timothy Murphy Coroner
Address
52 Haviland Avenue,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
Cit ,Town or Village 5601 384
Burial Date Cemetery,Crematory or Facility Name
07/25/2022 Pine View Crematory
Entombment Address
Cremation Queensbury,New York
DDonation
DRemoval Date Place Removed
and/or and/or Held
N Hold Address
0
0. Date Point of
U)❑Transportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
D 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
i— Remains are Shipped,If Other than Above
S Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/25/2022 Registrar of Vital Statistics AisganNo!in ectnn:1w*4n4
(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 -7-26-ZOZL Place of Disposition ( t.,)P t:,•e-,A) Cr , t-j
2 (address)
W
N
cc (section) (l numb / (grave number)
8 Name of Sexton or Person in Cha e of Premis TA7 O^t_ Li co
z
(please print)
uJ Signature4i Title Og Ueli
o
/
DOH 1555(07/18)p i of 2
Public Health Law Sec. 4145(2b)
1 P, 2
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#