Ringler, Stephen Michael - .\\ILS,l) 4 gs-10
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Stephen Michael Ringler Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/27/2022 69 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 84 Burnt Hills Drive,Queensbury Town,New York 12804
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41 W ri Manner of Death Natural Cause nAccident 1-7n
Homicide Suicide Undetermined ❑Pending
V ' (Circumstances Investigation
au Medical Certifier Name Title
G Timothy Murphy Coroner
Address
52 Haviland Avenue,Glens Falls,New York 12801
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 161
▪Burial Date Cemetery,Crematory or Facility Name
10/31/2022 Pine View Crematory
IllEntombment Address
Cremation Queensbury,New York
▪Donation
ORemoval Date Place Removed
and/or and/or Held
CO Hold Address
0
d• Date Point of
iI Transportation
Q by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
Reinterment
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
} Remains are Shipped,If Other than Above
Address
Q
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/31/2022 Registrar of Vital Statistics Carolnexklegard Barb-er(EYectronicaf Signee
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
\\:Z Date of Disposition /01311 tt Place of Disposition `1 r...,Vi_- (Jfr--
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2 (address)
W
I (section) (lot number) (grave number)
Name of Sexton or Person in Charge of i s (
Z (p case print)
Signature Title rp644N ✓e,
i-1555(07/18)p 1 of 2
01, 3
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#