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Palmer, Jonathan A
10 ) -it 163 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Jonathan A.Palmer Male Date of Death Age If Veteran of U.S.Armed Forces, 02/12/2023 79 Years War or Dates H Place of Death Hospital,Institution or ZW O City,Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death ID Natural Cause Accident Homicide Suicide Undetermined riPending W Circumstances Investigation W Medical Certifier Name Title G Sandita Seecharan MD Address 4573 State Route 40,Argyle Town,New York 12809 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 89 Burial Date Cemetery,Crematory or Facility Name 02/16/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury,New York Donation oRemoval Date Place Removed c and/or and/or Held QN Hold Address a Date Point of fn❑Transportation Shipment 5 by Common Carrier Destination ODisinterment Date Cemetery Address Reinterment 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 i.. Remains are Shipped,If Other than Above g Address R W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/16/2023 Registrar of Vital Statistics Megan Noli'n(ECectronicalTy 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: I— Z Date of Disposition 2i 11 I 73 Place of Disposition rtiV ,e t'- W (address) W Cl) (section) / (lot number) (grave number) Q 0 Name of Sexton or Person in Charge oemises AO/ea e print) Z Z___,..4 WTitle f IzEmw IK Signature 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#