Staunches, Edward William NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Edward William Staunches Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/04/2023 76 Years War or Dates 1966-1970
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
W Manner of Death Undetermined Pending
Natural Cause Accident Homicide Suicide g
W Circumstances Investigation
W Medical Certifier Name Title
Courtney Diamond NP
Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 67
Burial Date Cemetery,Crematory or Facility Name
02/06/2023 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
g❑Removal Date Place Removed
and/or and/or Held
H Hold Address
0
d Date Point of
N❑Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
❑Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
l- Remains are Shipped,If Other than Above
Address
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/06/2023 Registrar of Vital Statistics Megan No&n(Electronically Signed)
(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
W Date of Disposition l��(is Place of Disposition �n„V
,2 (address)
W
CC CC (section) (lot number) (grave number)
0 Name of Sexton or Person in C rge of Premises
Z (please print)
W Signature Title
DOH-1555(07/18)p 1 of 2
Oi66Th
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#