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Moffre, Peter Joseph Jr.
r ° LF NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Peter Joseph Moffre Jr Male Date of Death Age If Veteran of U.S.Armed Forces, 11/21/2023 82 Years War or Dates Marines H Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 161 Luzeme Road,Queensbury Town, New York 12804 O Manner of Death Natural Cause Accident ❑Homicide OSuicide Undetermined ri Pending Circumstances Investigation WMedical Certifier Name Title O Kasuni Kotelawala MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 175 Burial Date Cemetery,Crematory or Facility Name 11/24/2023 Pine View Crematory Entombment Address ©Cremation Queensbury,New York Donation 0❑Removal Date Place Removed and/or and/or Held pN Hold Address (/)ElTransportation Date Point of 5 by Common Shipment Carrier Destination O 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 • Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/24/2023 Registrar of Vital Statistics Caroline xYCegar6e 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: W Date of Disposition j/—27.Z17"L3 Place of Disposition j ,yt 2. ;c v' t rim 2 (address) W V) CC (section) (lot number) (grave number) O Name of Sexton or Person in rge of Premises L'I Ge, m -e- Z (please print) W Signature Title �T2 r t 44/ " DOH-1555(07/18)p 1 of 2 f 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#