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Balfour, Craig M ZZ9 CLF.' NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Craig M.Balfour Male Date of Death Age If Veteran of U.S.Armed Forces, 03/06/2023 47 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital el el Manner of Death n Undetermined Pending l l Natural Cause Accident Homicide Suicide WCircumstances Investigation Ui Medical Certifier Name Title 0 Bo Li MD Address 100 100 Park St,Glens Falls,New York 12801 DeaRth Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 128 Burial Date Cemetery,Crematory or Facility Name 03/09/2023 Pine View Crematory Entombment Address ,:;©Cremation Queensbury Town,New York - ODonation Removal Date Place Removed and/or and/or Held CO Hold Address 0 d Date Point of Cl)❑Transportation Shipment 5 by Common Carrier Destination ;,, ❑Disinterment Date Cemetery Address `, Reinterment Date Cemetery Address a Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 n § Name of Funeral Firm Making Disposition or to Whom ,, Remains are Shipped,If Other than Above Address E Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/08/2023 Registrar of Vital Statistics Megan Nolin( ctronicall;Srgned) (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: Date of Disposition 3111`V Place of Disposition IL.. W (address) W cc cc (section) (lot number) (grave number) - k✓! g Name of Sexton or Person in Charge of Premises 4,),L. !rA (please print) W Signature Title Wi 1Z- DOH-1555(o7/18)p 1 of 2 I . . U: -- .: 77 Public Health Law Sec. 4145(2b) 1 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial perm' Official Funeral Directors Reg.or License# 1