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Church, Joseph NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Joseph Church Male Date of Death Age If Veteran of U.S.Armed Forces, 09/19/2023 36 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Moreau Town Street Address 1411 9 Route 5,Moreau Town,New York 12803 p Manner of Death 0 Natural Cause Accident ❑Homicide Suicide Undetermined Pending ILI 0 Circumstances Investigation CMedical Certifier Name Title Susan Hayes-Masa Coroner Address 40 McMaster Street,Ballston Spa Village,New York 12020 Death Certificate Filed Town Of Moreau District Number Register Number City,Town or Village 4562 52 Burial Date Cemetery,Crematory or Facility Name 09/23/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York DDonation goRemoval Date Place Removed and/or and/or Held F— Hold Address N 0 a Date Point of t/)ETransportation S by Common Shipment • Carrier Destination Disinterment 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 -. Remains are Shipped,If Other than Above S Address CC IJJ O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/22/2023 Registrar of Vital Statistics Brenda.7futter(E(ectronicaCCySigned) (signature) District Number 4562 Place Town Of Moreau I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition 9z3—ZOZ3 Place of Disposition p;,ip I/re,v Cre,,tq�, 2 (address)S W CO Q • (section) (lot norther) (grave number) 0Name of Sexton or Person in Char f Pre�t' e ' k 'MD.J i I p W �9 // / (please print) Signature T �ss �j/// Title 'r DOH-1555(07/18)p 1 of 2 1 '7 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#