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Huck, Chester Blake A .A15?r NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Chester Blake Huck Male Date of Death Age If Veteran of U.S.Armed Forces, 06/22/2023 68 Years War or Dates Air Force i_ Place of Death Hospital,Institution or W City,Town or Village Lake George Town Street Address 3620 Lake Shore Drive,Lake George Town,New York 12845 p Manner of Death El Natural Cause Accident Homicide Suicide Undetermined ri Pending LU Circumstances Investigation W Medical Certifier Name Title O John Sawyer MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Lake George District Number Register Number City,Town or Village 5651 5 Burial Date Cemetery,Crematory or Facility Name 06/24/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held ~ Hold Address CO 0 d Date Point of (I) Transportation a- by Common Shipment Carrier Destination Ei Disinterment Date Cemetery Address ElReinterment 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 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/23/2023 Registrar of Vital Statistics Patricia 2Z,911c7(jnney Schuster(ECectronica1ty 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 41 U Place of Disposition , /._. 4_ 2 (address) W NCC (section) (lot number) (grave number) O Name of Sexton or Person in Charge of Premises9 "� 0 (please print/ iu /�z- lU reynOZ Signature Title 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#