Gale, Michael Joseph Sr. i
L.F)
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Michael Joseph Gale Sr Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/20/2022 65 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
0 Manner of Death ❑X Natural Cause Accident ❑Homicide DSuicide Undetermined ElPending
0 Circumstances Investigation
g Medical Certifier Name Title
Scott Biasetti 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 644
Burial Date Cemetery,Crematory or Facility Name
12/22/2022 Pine View Crematory
_Entombment Address
NICremation Queensbury,New York
❑Donation
Z Removal Date Place Removed
and/or and/or Held
}= Hold Address
N
0
0. Date Point of
t/1❑Transportation Shipment
by Common
Carrier Destination
Ei
Disinterment
Date Cemetery Address
p Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
,1 53 Quaker Rd,Queensbury,New York 12804
'2"1 Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
Permission is hereby g ranted to dispose of the human remains described above as indicated.
Date Issued 12/22/2022 Registrar of Vital Statistics Megan Wolin(ECectronicaCCySigned)
(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:
Date of Disposition if-Z3-Zo ZZ Place of Disposition r e V.''eJ Creoj'd'�
W 2 (address/ ,�
to
t (section/ (lot num / i (grave number)
8 Name of Sexton or Person in Cha a of P' ses (1 I4 Ym' LIN,
(please print)
W Signature Title Ole �(�ar
DOH-1555(o7/18)p 1 of 2
6 s "it,
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#