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Drellos, Christopher Laurence j 45 I-\5/ NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Cristopher Laurence Drellos Male blroirgth Age If Veteran of U.S.Armed Forces, 02/12/2023 33 Years War or Dates H Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 12 Morgan Drive, Queensbury Town, New York 12804 O Manner of Death El Natural Cause Accident ❑Homicide Suicide Undetermined EaPending ILI Circumstances Investigation W Medical Certifier Name Title 0 Timothy Murphy Coroner Address 52 Haviland Avenue,Glens Falls,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 26 Burial Date Cemetery,Crematory or Facility Name 02/15/2023 Pine View Crematory Entombment_ Address ©Cremation Queensbury,New York Donation ' 0 0 Removal Date Place Removed and/or and/or Held ~ Hold Address W 0 IL ElTransportation Date Point of $ by Common Shipment Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address El Reinterment 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 Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/15/2023 Registrar of Vital Statistics Caroline 2fi&fegarde Barber(E(ectronicallySigned) (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: Z Date of Disposition 2 j, 1t Place of Disposition -'Z,IL W 2 (address) W O(section) it num[ter/ �h (grave number) O Name of Sexton or Person in Charge of P Praises z (pleas print) al Signature Title 1rri i�r DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 1 ' E Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#