Merbler, Ernest F - L.:01 4 --)
NEWYORKSTATEDEPARTMENTOFHEALTH G
Bureau of Vital Records Burial _ Transit Permit
Name First Middle Last Sex
Ernest F.Merbler Male
Date of Death Age If Veteran of U.S.Armed Forces,
09/16/2022 89 Years War or Dates 1953-1955
F Place of Death Hospital,Institution or
ZCity,Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death ID Natural Cause DAccident Ei Homicide DSuicide riUndetermined ❑Pending
W
U Circumstances Investigation
W Medical Certifier Name Title
CI BoU MD
Address
100 100 Park St,Glens Falls,New York 12801
Death Certificate Filed �y Of Glens Falls District Number Register Number
E
Cit ,Town or Village 5601 474
Burial Date Cemetery,Crematory or Facility Name
09/19R022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0 El Removal Date Place Removed
F and/or and/or Held
co Hold Address
0
4. Date Point of
Cl) Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
EIReinterment 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
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/19/2022 Registrar of Vital Statistics Alvan Yam( scti»nSc l6,4n1J)
(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 1120I4 Place of Disposition ,IL I,14—_
2 (address)
W
N
Q (section) fiat number/ (grave number)
gName of Sexton or Person in Cha remises 14s
Z lease print/
W Signature title if---
/} 14
�„e
DOH 1555(07/18)pi of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representingathe funeral home named on burial permit
Official Funeral Directors Reg.or License#