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Duffy, John Patrick e. # 33y NEW YORK STATE DEPARTMENT OF H EALTH R. Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex John Patrick Duffy Male Date of Death Age If Veteran of U.S.Armed Forces, 04/07/2023 75 Years War or Dates 1969-1971 F i_ Place of Death Hospital,Institution or Z City,Town or Village South Glens Falls Village Street Address 121 Hudson Street,South Glens Falls Village,New York 12803 111 p Manner of Death Eli Natural Cause nAccident ri Homicide 0 Suicide n Undetermined El Pending U (Circumstances I 'Investigation ILIQ Medical Certifier Name Title David Cunningham MD Address 3 Irongate Center,Glens Falls,New York 12801 Death:Certificate Filed Village Of South Glens Falls District Number Register Number City,Town or Village 4524 8 riBurial Date Cemetery,Crematory or Facility Name 04/11/2023 Pine View Crematory nEntombment Address ©Cremation Queensbury Town,New York E—jDonation 0❑Removal Date Place Removed and/or and/or Held I Hold Address N 0 d Date Point of (n❑Transportation p by Common Shipment Carrier Destination riDisinterment Date Cemetery Address — Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom F— Remains are Shipped,If Other than Above Address CC W Q. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/11/2023 Registrar of Vital Statistics Sam{zrit/iuWery(6leitronu:aiy,cj#er) (signature) District Number 4524 Place Village Of South Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z "7 i Z Date of Disposition 9 I li)1; Place of Disposition .„�(/ 111 2 " (address) W U) Q (section) (lot number) �` (grave number) A0 Name of Sexton or Person in Charge o emises N �— --\ 1� Z /tpease print) W Signature Title ("f`httze) DOH-1555(07/18)p 1 of 2 3 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#