Kane, Gerald Joseph . LF ') -A -) s-c
NEW YORK STATE DEPARTMENT OF HEALTH / Burial - Transit Permit
Bureau of Vital Records A,,
Name First Middle Last Sex
Gerald Joseph Kane Male
Date of Death Age If Veteran of U.S.Armed Forces,
09/22/2022 86 Years War or Dates Marine
i_ Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address 390 Church Street, Saratoga Springs, New York 12866
LU
p Manner of Death []Natural Cause IllAccident ❑Homicide El Suicide 111Undetermined riPending
W Circumstances Investigation
W Medical Certifier Name Title
Ci Madison Zuis NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed City Of Saratoga Springs District Number Register Number
City,Town or Village 4501 557
Burial Date Cemetery,Crematory or Facility Name
09/23/2022 Pine View Crematory
Entombment Address
Cremation Queensbury,New York
DDonation
❑Removal Date Place Removed
and/or and/or Held
~ o Hld Address
N
O
a. Date Point of
(A❑Transportation
CI Common Shipment
Carrier Destination
EDisinterment Date Cemetery Address
Reinterment 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
F Remains are Shipped,If Other than Above
2 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/23/2022 Registrar of Vital Statistics 'Di((on 9Koran(E(ectronica((ySigned
(signature)
District Number 4501 Place City Of Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 9 113I 71 Place of Disposition ��4IL (!tr----
2 (address)
W
CC (section) 1 (lot number) (grave number)
tt
0 Name of Sexton or Person in Charge of Premise A ati�a`se print) ,
Z /N!e
LU Signature Title c ,4 All rat
DOH-1555(07/18)p 1 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#