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King, Raymond L # 32.9 NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Raymond L King Male Date of Death Age If Veteran of U.S.Armed Forces, 04/07/2023 85 Years War or Dates Army .„, Place of Death Hospital,Institution or ill City,Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death El Natural Cause lilAccident Homicidelil Suicide Undetermined Pending Circumstances Investigation AV Medical Certifier Name Title Mathew Varughese DO Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 182 ▪Burial Date Cemetery,Crematory or Facility Name 04/10/2023 Pine View Crematory ❑Entombment Address ©Cremation Queensbury Town,New York ▪Donation Z Removal Date Place Removed and/or and/or Held 0 Hold Address Transportation Date Point of s by Common Shipment Carrier Destination „ ❑Disinterment 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 A Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/10/2023 Registrar of Vital Statistics 9Kegan Wo/in(ECectronicaCCySigned) (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: Pli Date of Disposition uI i Il i�3 Place of Disposition -7,-.V ,lf�_... (address) W IA IC (section) 1 (tot number) C (grave number) Name of Sexton or Person in Charge of Premis s '' L.- �-�""A II /p ase print) ILI Signature ,--7 Title (ttr0gtp2 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#