McIntyre, Christopher Thomas # IDoz
i 11.7.1F.
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Christopher Thomas McIntyre Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/16/2022 39 Years War or Dates
▪ Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address 9 New Pruyn Street,Glens Falls,New York 12801
W• Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
NU Medical Certifier Name Title
O Timothy Murphy Coroner
Address
52 Haviland Avenue,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 635
Burial Date Cemetery,Crematory or Facility Name
12/19/2022 Pine View Crematory
Entombment— Address
IIICremation Queensbury Town,New York
Donation
Z Removal Date Place Removed
and/or and/or Held
F- Hold Address
N
0
O. Date Point of
V) Transportation
Q by Common Shipment
Carrier Destination
111
Disinterment
Date Cemetery Address
CIReinterment 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
Remains are Shipped,If Other than Above
Address
d Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/19/2022 Registrar of Vital Statistics Megan No(in(Erectronicarry 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: /
--.. 1
2W Date of Disposition I 217a t Z Z. Place of Disposition ..AIL-
2
(address)
W
CC (section) // .Not number) (grave number)
SName of Sexton or Person in Charge of Premises L .- <_- /",,Ct
Z 7 (pitlase print)
W at VCID it-K
Signature Title
DOH-1555(07/18)p 1 of 2
• ,p...ri<.): . 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#