Huppert, Charles ,i It
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NEW YO R K STATE DEPARTMENT OF HEALTH �"�
Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Charles Huppert Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/30/2022 94 Years War or Dates Navy
i_ Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 11 Caitlin Drive,Queensbury Town,New York 12804
p Manner of Death l Natural Cause Accident Homicide Suicide ❑Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
G Christopher Mason DO
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 195
Burial Date Cemetery,Crematory or Facility Name
01/03/2023 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
g❑Removal Date Place Removed
and/or and/or Held
H Hold Address
CO
0
O. Date Point of
U)El Transportation
p 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
1— Remains are Shipped,If Other than Above
2 Address
fr
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/02/2023 Registrar of Vital Statistics Caroline xCCegarrte Barber(ECectronicalty Signed)
(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:
E— �,/�
ZIIJ Date of Disposition ) I`1 I13 Place of Disposition AL "mot'
2 (address/
W
NCt (section) (/gt number) (grave number)
gName of Sexton or Person in Ch of Premises "A ti
W /✓Signature Title ((P ase print/
P ✓A
W
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt (1.1N7txi
Human remains o delivered on , 20
e View Cemetery Representing the funeral home named on burial permit
.1 Funeral Directors Reg.or License#