Daly, Dennis Town of Queensbury
v./co
of Cremation
� Pine View Cemetery and Crematory
This certifies that the remains of: Dennis Daly
were cremated on November , 3 20 22 at the Pine View
(Month) (Day)
Crematorium, Queensbury,New York, and these are the cremated remains of said body.
Date of Death October , 29 20 22 Age 60
(Month) (Day)
Funeral Home Carleton Funeral Home Registered No. 866
(Authorized Signature)
LF ,
NEW YORK STATE DEPARTMENT OF H EALTH ., - Transit Permit
Bureau of Vital Records Burial
Name First Middle Last Sex
Dennis Keeffe Daly Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/29/2022 60 Years War or Dates 1983-2007
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death Undetermined Pending
El Natural Cause Accident Homicide Suicide
W Circumstances Investigation
U
W Medical Certifier Name Title
Sean Bain MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 554
Burial Date Cemetery,Crematory or Facility Name
11/03/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury,New York
Donation
0 Removal Date Place Removed
• and/or and/or Held
H N Hold Address
0
d Date Point of
(I) Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
Address
CC
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/02/2022 Registrar of Vital Statistics Megan NoCin(E(ectronicalty Signed)
(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:
2
W Date of Disposition JJ J3�ZZ Place of DispositioYmidress)
2
W
N
CC (section) 41..(lot number) (grave number)
GName of Sexton or Person in Charge of PremisesP/ eprint/ 111.
Z �f�i ► <
W Signature ��' " _ Title
DOH-1555(07/i8)p t of 2
1 r - 7 5
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#
DALY
NAME Dennis / Age:
s Daly ! 60
Lot Owner: Leonard A DAly
Lot# Erie 18D Grave# 2/6
Case: Urn
Died: 1 0.2 9.2 2 Interred: 1 1 .5.2 2
Funeral Home: Carleton FH
Cemetery: Pine View
,
DALY (i:)?) Lot No. 18D
Address 5 County Route 41 Hudson Falls, NY 12839
Section NO.
Owner Plot
Tt]nard A IIa 1 y.p Erie
Date 3/9/2012
Approx. 109 Superficial ft. e
Location Bounded on the North _by Paculavich, East by Vacant
West by Road and South by Dineen
Corner Posts
Remarks 792-3020
Deed No. (and changes) 3764
Payment Record Paid in f kl on 3/9/2012 ( ct1 , R00_001
Record of Interments
i -EOiJ14r2 (,5hvq) 19
2/5 Heather Daly J 6/29/1 2 Crem, ) I [z P
�I
3 Cor\ee E ered,) i\ C(I40 ��n,sai 1I-s-aa�� ll)-3R- DQ ry L
s HI , - A
,_
V
11 1 Z 3 N. C
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A
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Form No. 01