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Stewart, Ronald Howard Sr. NEW YORK STATE DEPARTMENT OF HEALTH (To: Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Ronald Howard Stewart Sr Male Date of Death Age If Veteran of U.S.Armed Forces, 12/16/2022 84 Years War or Dates Navy Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address 16 Washburn Avenue,Glens Falls, New York 12801 p Manner of Death El Natural Cause EAccident Homicide Suicide Undetermined Pending WWCircumstances Investigation Medical Certifier Name Title Aimee Mcmaster Nurse Practitioner,Acute Care Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 633 ©Burial Date Cemetery,Crematory or Facility Name 12/20/2022 Pine View Cemetery III Entombment Address Cremation Queensbury,New York DDonation Removal Date Place Removed and/or and/or Held pHold Address O O. Date Point of (/)El Transportation a by Common Shipment Carrier Destination Disinterment 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 H Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/19/2022 Registrar of Vital Statistics Megan Wolin(Electronically 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: N� a� W Date of Disposition k _ate ola Place of Disposition @ i (��CiZ -R lSl 2 (address) w �Rie '7 V- cr (section/7-7 (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises I e. �-7 C.9 e G# Z (please print) W Signature 44;4 dey_ Title DOH-1555(07/18)pi of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of ;` delivered on / , 201` i /Pine View Cemetery Representing the funeral Tome named on burial permit ' Official Funeral Directors Reg.or License# , V< , STEWART 'j ,..: ' NAME Ronald H Stewart y`' Age: 84 Lot Owner: Ronald H & Terri K Stewart Lot# Erie 77C Grave# 1 Case: Concrete Died:1 2. 1 6.2 2 Interred: 1 2.2 0.2 2 Funeral Home: Regan Denny Stafford Cemetery: Pine View