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Metz, Charles Jr.
—Acroftfs\ NEW YORK STATE DEPARTMENT OF HEALTH 1 Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Charles Metz Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, 07/31/2023 84 Years War or Dates Air Force F Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 26 Waverly Place,Queensbury Town, New York 12804 p Manner of Death Z Natural Cause Accident Homicide 0Suicide Undetermined Pending W Circumstances Investigation WMedical Certifier Name Title O Anthony Petracca MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 120 Burial Date Cemetery,Crematory or Facility Name 08/02/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Z Removal Date Place Removed and/or and/or Held H Hold Address N 0 O. Date Point of (r) Transportation Shipment G by Common Carrier Destination Disinterment Date Cemetery Address El 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 , . Remains are Shipped,If Other than Above ZE Address IX Itl O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/01/2023 Registrar of Vital Statistics Caroline 2fi&fegarde Barber(ECectronicalty 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: ll W Date of Disposition U Z,r jpZ 3 Place of Disposition E v i'e vJ C re'Mrc+a (address) W CC (section) A,� J, (lot number) (grave number) Name of Sexton or Person in Charg of Premi s /�4 r/0,J 1� '✓B11 C z /s� ( (please print) W /lamPsl�� c Signature �__ ` Title D 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#