Kingrey, Glenn W tr
NEW YORK STATE DEPARTMENT OF HEALTH LF Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Glenn W.Kingrey Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/24/2022 60 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death n nEll Undetermined nPending
W I I Natural Cause Accident I I Homicide Suicide
Circumstances I 'Investigation
W Medical Certifier Name Title
O Bo Li MD
Address
100 100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 658
Burial Date Cemetery,Crematory or Facility Name
12/30/2022 Pine View Cemetery Crematory
Entombment Address
X Cremation Queensbury Town,New York
Donation
I I Removal Date Place Removed
and/or and/or Held
ā Hold Address
)
0
0. Date Point of
Cl) Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Tunison Funeral Home 01730
Address
105 Lake Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
lā Remains are Shipped,If Other than Above
m Address
CC
W
0. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/30/2022 Registrar of Vital Statistics _leganAlaCrn gYectranicalr Spnerl9
(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:
Z Date of Disposition IN IL) Place of Disposition -,., _ _
ILI (address)
W
N CC (section/ , (lot number) (grave number)
L,
O Name of Sexton or Person in Charge of Premis
(p1 se print)
W Signature Title (i0447) ut
DOH-1555(o7/18)p t of 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#