Reilly, James F rib
ki
NEW YORK STATE DEPARTMENT OF HEALTH -a. ��Vital Records Section
Burial - Transit Permit
Name First Middle Last Sex
James F Reilly Male
Date of Death Age If Veteran of U.S. Armed Forces,
8/8/2019 81 War or Dates
Place of Death Hospital, Institution or
City,Town or Village Queensbury Street Address 5 Centennial Drive
Manner of Death 0 Natural Cause n Accident E Homicide n Suicide n Undetermined Pending
Circumstances Investigation
Medical Certifier Name ,.,' - Title
1
. __ _ —C+s - t °'N —_— K._
Address
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Death Certificate Filed Distract Number F ei Regift Number
v.„.. City,Town or Village Queensbury 5657 i i ►►
0 Burial Date Cemetery or Crematory
August 9,2019 Pine View Crematorium
EllErkombment
Address
®Cremation 51 Quaker Road,Queensbury,NY 12804
Date ( Place Removed
fl Removal and/or Held
and/or
Address
Hold
Date Point of
co 0 Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
' Permit Issued to Registration Number
_-, Name of Funeral Home Regan Denny Stafford Funeral Home 01443
' Address
53 Quaker Road,Queensbury,r NY 12804 __..__ ____
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is here y granted to dispose of the human remain describe�d aboveas indicated.
Date Issued Registrar of Vital Statistics -- C- c:. A- -___
(signature)
District Number 5657 Place Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition gih iii Place of Disposition R Le [ {s,r_—
W (address)
M
iY (section) nu (grave number)
p Name of Sexton or Person in Charge of Premises (tat
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Signature G,( ,, -- Title fMaYi lit.
(over)
DOH-1555(02/2004)
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Town of Queensbury /
Certification of Cremation
W4r Pine View Cemetery and Crematory
This certifies that the remains of: James Reilly
were cremated on August , 9 20 19 at the Pine View
(Month) (Day)
Crematorium. Queensbury, New York, and these are the cremated remains of said body.
Date of Death August , 8 20 19 Age 81
(Month) (Day)
Funeral Home Regan Denny Stafford Registered No. 524
41
(Authorized Signature)
Reilly LQF Lot No. 27-C
Address 5 Centennial Drive Queensbury N.Y. 12804 Section No. Horican
Owner James & Norma Reilly Plot
Date 6/18/07
Approx 33 Superficial ft.
Location Bounded On North ByVacant, South By Vacant, West BY Vacant, East By Cavanagh.
Corner Posts
Remarks Phone 7935060
Deed No. f and changes) 3491
Payment Record 6/18/07 Paid In Full ($550.00)
Record of Interments
`— r / P CA
taCl James Reilly 8/12/2019 (crem) v a al V
2 /VGA nL O 42&.. _,
4 PI \IL \V) (j
_. . CAVAPR(rEl
Form No. 01
NAME James Reilly Age: 81
LotOwnerJames & Norma Reilly
Lot# Horicon 27-C Grave# 1
Case:metal
Died:8/8/2 01 9 Interred:8/1 2/2 01 9
Funeral HomeRegan Denny Stafford
Cemetery:pine View