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VanAmburgh, Ryan Bud
11/a1/G NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Ryan Bud Van Amburgh Male Date of Death Age If Veteran of U.S.Armed Forces, 12/25/2023 44 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address 35 Franklin Street,Glens Falls,New York 12801 p▪ Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title CI John Stoutenburg MD Address 100 Park St,Glens Falls,New York 12801 • Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 612 Burial Date Cemetery,Crematory or Facility Name 12/27/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation OZ Removal Date Place Removed and/or and/or Held N Hold Address 0 a Date Point of N) Transportation p by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address EIReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom i.. Remains are Shipped,If Other than Above a Address Q W 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/27/2023 Registrar of Vital Statistics Megan Wolin(ECectronicaITy Signed) (signature/ District Number 5601 Place City Of Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H W Date of Disposition /Z Zg'Z&3 Place of Disposition rJQ I/,eJ Ct js-/a rA 2 (address) W N CC (section) (lot number) (grave number) 8 Name of Sexton or Person in Charge of Pr ises —RArh b,�� nd / (please print) W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) (Ja5_ ! ( Receipt Human remains of '° 't delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# 1' `