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Murray, John C —(115) LfZ NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records , Name First Middle Last Sex John C Murray Male Date of Death Age If Veteran of U.S.Armed Forces, 05/12/2023 57 Years War or Dates F Place of Death Hospital,Institution or Z City,Town or Village Lake George Town Street Address 1766 State Route 9 Cabin 2,Lake George Town,New York 12845 ILJ p Manner of Death 0 Natural Cause Accident 0 Homicide ESuicide nUndetermined Pending W o Circumstances Investigation ILI G Medical Certifier Name Title Connie Goedert Coroner Address 1400 St Route 9,Lake George Town,New York 12845 Death Certificp Filed Town Of Lake George District Number Register Number City,Town or Village 5651 4 Burial Date Cemetery,Crematory or Facility Name 05/17/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation ZRemoval Date Place Removed and/or and/or Held H Hold Address N 0 O. Date Point of N 0 Transportation a by Common Shipment Carrier Destination ElDisinterment 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 1— Remains are Shipped,If Other than Above a Address Q W 1:1 Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/17/2023 Registrar of Vital Statistics Patricia cR lic?(inney Schuster(E(ectronica1Ty Signed) (signature) District Number 5651 Place Town Of Lake George I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z / W Date of Disposition S�t� Z3 Place of Disposition �14J `.,;4� 2 (address) W N Ir (section) / (lot number)— (grave number) Name of Sexton or Person in Charge of Premises / /�n IL— Z please print) / W Signature Title DOH-1555(07/18)p 1 of 2 ,' wr _ t ' b'``"a _. to eea 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#