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Case,John J
NEW YORKSTATE DEPARTMENT OF HEALTH .-1 .,f) Burial - Transit Pe Lit Bureau of Vital Records Name First Middle Last Sex John J Case Male Date of Death Age If Veteran of U.S.Armed Forces, 01/15/2024 76 Years War or Dates ♦., Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital 0 Manner of Death a Natural Cause Accident ❑Homicide El Suicide FlUndetermined ri Pending W Circumstances Investigation WMedical Certifier Name Title 0 Marcille Labban 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 33 Burial Date Cemetery,Crematory or Facility Name 01/18/2024 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York IliDonation 8❑Removal Date Place Removed and/or and/or Held NHold Address 0 a. Date Point of U) Transportation Shipment es by Common Carrier Destination Ei Disinterment Date Cemetery Address 111 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 H Remains are Shipped,If Other than Above ,a Address ft W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/17/2024 Registrar of Vital Statistics Megan.NoCin(E(ectronicallySigned) (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: I— Z Date of Disposition I I IgI2 y Place of Disposition ..f'J f(4<.-.) (TACAllIVt'r- UJ 2 (address) W NCC (section) (tot n ber) (grave number) 0 Name of Sexton or Person in Charge of mises �� - A. Z lease print) Z W Signature Title l f nl DOH-1555(07/18)p 1 of 2 y @...► `_ 8 G 4 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial .ermit Official Funeral Directors Reg. or License#