Weaver, Zachary 9 z
,
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Zachary Weaver Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/25/2023 51 Years War or Dates
Place of Death Hospital,Institution or
Ill City,Town or Village Glens Falls Street Address Glens Falls Hospital
el Manner of Death II Natural Cause Accident Homicide OSuicide ❑Undetermined riPending
W Circumstances Investigation
WI Medical Certifier Name Title
O Gamal Khalifa 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 52
R Burial Date Cemetery,Crematory or Facility Name
01/27/2023 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Q 0Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
0• Date Point of
t/)ETransportation
ES Common Shipment
',;; Carrier Destination
ODisinterment Date Cemetery Address
ElRe interment 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
IX
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O.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/27/2023 Registrar of Vital Statistics Megan Wolin(r(ectronicallySigned)
(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:
IH
WDate of Disposition /2 2'U23 Place of Disposition 2,J e 0 c e„V Cre--ytv-„ ,t
2 (address)
iW
MC (section) of nu er) (grave number)
8 Name of Sexton or Person in Cha a of Prem. e 'ill) tx) 00
Z ` / (please print)
W Signature !r' Title CP ;'tet r
DOH-1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on.?yrral permit
Official Funeral Directors Reg.or License#