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Hoopes, Samuel P 111 4132- @ , N EW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Samuel P Hoopes III Male Date of Death Age If Veteran of U.S.Armed Forces, 01/06/2024 69 Years War or Dates p Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death �Natural Cause Accident Homicide Suicide Undetermined ❑Pending 0 Circumstances Investigation QW Medical Certifier Name Title Asim Chaudry 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 13 Burial Date Cemetery,Crematory or Facility Name 01/09/2024 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation goRemoval Date Place Removed F and/or and/or Held N Hold Address 0 O. Date Point of N❑Transportation a 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 1— Remains are Shipped,If Other than Above a Address CC W 11' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/08/2024 Registrar of Vital Statistics Megan Wolin(ECectronica(51Signed) (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: IH Z Date of Disposition 1110174 Place of Disposition iJ v rr,J rizi wile (1-- (address) W N 2 (section) 7 (lot nrtmber) (grave number) 8 Name of Sexton or Person in Charge of Premises v�„r.i L. �Lw.,N Z /L.� (P/ se print) iL Signature / j/ Title `mot"' rue 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#