Rowe, Peter " NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last I Sex
Peter Rowe Male
°ll1 Date of Death Age If Veteran of U.S. Armed Forces,
April 10, 2011 72 f War or Dates
i
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death UndeterminedPending
X]Natural Cause 1 I Accident I Homicide 1 Suicide end ng
til Circumstances I Investigation
u; Medical Certifier Name Title
11 James North MD
Address
100 Broad Street GlensFalls,NY 12801
Death Certificate Filed ; District Number Register Number
y; _ City, Town or Village Glens Falls 5601 /73
ED Burial Date Cemetery or Crematory
April 14, 2011 Pine View Cemetery
Entombment Address
❑Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z I I Removal and/or Held
O and/or Address —
H Hold
O Date Point of
N I 1 Transportation Shipment
p by Common Destination
Carrier
—
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton- Healy Funeral Home 01622
s Address
407 Bay Road, Queensbury, NY 12804
• Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
AMP
Address
lit— _
Permission is hereby granted to dispose of the human remains des
ri d ove s In e .
Date Issued 0`7/3/ZD// Registrar of Vital Statistics EGG'� Prf r ys
(signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 4/14/11 Place of Disposition Pine View Cemetery
W (address)
U) Free Ground 49
(section) (lot number) (grave number)
Q Name of Sexton or Person in Charge of Premises Michael Genier
Z -. (please print)
W Signature 4 .. Title Superintendent
(over)
DOH-1555(02/2004)