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Cross Jr., Harry V
- 14 if SZo NEW YORK STATE DEPARTMENT OF HEALTH , -_— __ __ Burial - Transit Permit Bureau of Vital Records _ Name First Middle Last Sex Harry V.Cross Jr Male Date of Death Age If Veteran of U.S.Armed Forces, 06/25/2023 74 Years War or Dates Place of Death Hospital,Institution or ILU Z City,Town or Village Queensbury Town Street Address 24 Pine Cone Drive,Queensbury Town,New York 12804 p Manner of Death El Natural Cause Accident 0 Homicide 0Suicide Undetermined Pending 11.1 0 Circumstances Investigation wG Medical Certifier Name Title Jessica Cutler NP Address 3 3 Irongate Ctr,Glens Falls,New York 12801-3471 Death Certificate Filed Town Of Queensbury District Number egister Number City,Town or Village 5657 6 Burial Date Cemetery,Crematory or Facility Name 06/27/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 0- Date Point of N)❑Transportation p by Common Shipment Carrier Destination Date Cemetery Address ❑Disinterment 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 E« Remains are Shipped,If Other than Above j Address LC w O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/26/2023 Registrar of Vital Statistics Carolnex0gard Barb-er(6/ctronicaf Signed) (signature) District Number 5657 Place Town Of Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: z w Date of Disposition 6 1?1(Z3 Place of Disposition 2 (address) w CO (section) / (lot number) (grave number) Name of Sexton or Person in Charge of Premises / !Il t''Nn L .(f-i Z (Tease print) 111 Signature Title �12C/hi '2 DOH-1555(o7/18)p t of 2 1 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#