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Lynch, Christopher Paul F S NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Christopher Paul Lynch Male Date of Death Age If Veteran of U.S.Armed Forces, 07/01/2023 75 Years War or Dates Army Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 695 Ridge Road,Queensbury Town, New York 12804 W Manner of Death Undetermined Pending W Natural Cause Accident Homicide Suicide g Circumstances Investigation W Medical Certifier Name Title 0 Douglas Dennett MD Address 101 Ridge Street,Glens Falls,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 106 Burial Date Cemetery,Crematory or Facility Name 07/06/2023 Pine View Crematory Entombment Address ©Cremation Queensbury,New York Donation ZO❑Removal Date Place Removed and/or and/or Held Hold Address N 0 a Date Point of (/)❑Transportation p by Common Shipment Carrier Destination ODisinterment 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 F. Remains are Shipped,If Other than Above g Address Q W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/06/2023 Registrar of Vital Statistics Caroline xGlegarcfe Barber(ECectronicaffySigned) (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 Date of Disposition 11 b 13 Place of Disposition 32; . ui (address) W N (section) (tot number/ (grave number) GName of Sexton or Person in Charge of r mises L Z (pease print) W Signature Title 6112 DOH-1555(07/18)p 1 of 2 ' y 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#