Loading...
Collette, Donald Francis �1-)9 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Donald Francis Collette Male Date of Death Age If Veteran of U.S.Armed Forces, 12/20/2019 74 Years War or Dates 1965-1972 �.. Place of Death FHospital,Institution or WCity,Town or Village Queensbury Town Address 7 Fox Farm Road, Queensbury Town, New York 12804 Manner of Death W ©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation ul Medical Certifier Name Title John Sawyer MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 192 ❑Burial Date Cemetery,Crematory or Facility Name 12/23/2019 Pine View Crematory ❑Entombment Address RI Cremation Queensbury Town,New York ❑Donation ❑Removal Date Place Removed and/or and/or Held U) Hold Address d a ❑Transportation Date Point of D by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address 1EIReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward, New York 12828 Name of Funeral Firm Making Disposition or to Whom I- Remains are Shipped,If Other than Above IAddress W I" Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/21/2019 Registrar of Vital Statistics Caroline.7fi(degarde Barber(ECectronicallySigned) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition /z,.-Z3,-l 9' Place of Disposition a (address) lu N (section) (lot number) (grave number) gName of Sexton or Pe 4,4-L Cz<,kl- Z (pleeas'e print) IU Signature Title DOH-1555(07/18)p 1 of Public Health Law Sec. 4145(2b) 01. 3174 Receipt Human remains of delivered on , 20_ Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#