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Gentry, Charles Richard \LOF . it I(ID rr NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Charles Richard Gentry Male Date of Death Age If Veteran of U.S.Armed Forces, 02/07/2023 82 Years War or Dates 1957-1978 l— Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing W Manner of Death Pending � I n I Natural Cause Accident Homicide nSuicide Undetermined n W U Circumstances ° 'Investigation W Medical Certifier Name Title CI Roslyn Socolof MD Address 42 Gurney Ln,Queensbury Town,New York 12804 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 21 HBurial Date Cemetery,Crematory or Facility Name 02/09/2023 Pine View Crematory — Entombment Address ©Cremation Queensbury Town,New York DDonation 0❑Removal Date Place Removed and/or and/or Held H N Hold Address 0 a Date Point of (/)DTransportation Shipment p by Common Carrier Destination Date Cemetery Address Disinterment Date Cemetery Address 0 Reinterment Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above N Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/08/2023 Registrar of Vital Statistics Caroline Hildegarde Barber(Electronically 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: I— - v. Z Date of Disposition ��j�Z-3 Place of Disposition t� �r p t ec,t, L r-e-'rL4: pJ (address) W N (sectionLre (lot umber) (grave number) CC 0 Name of Sexton or Person in Ch a of a ises P' ' � (/eaPorintl Z W Signature Title '` DOH-1555(07/18)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 burial permit Official Funeral Directors Reg.or License#