Horwitz, Richard Wolf NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Richard Wolf Horwitz Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/16/2020 81 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing
'p Manner of Death ❑Xill Natural Cause ❑Accident ❑Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Roslyn Socolof MD
Address
42 Gurney Ln,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 g
Burial Date Cemetery,Crematory or Facility Name
01/21/2020 Pine View Crematory
Entombment Address
X❑Cremation Queensbury,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
F- Hold Address
N
Transportation Date Point of
G by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/18/2020 Registrar of Vital Statistics CaroCsnexfdegard 0arAer(E&tronica1ySyffe4
(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:
W Date of Disposition Zj 10 Place of Disposition r ;,u,/ /Sm rL.—
(address)
W
(section) (tot number) c (grave number) j
SName of Sexton or Person in Charge of Premises I 1
Z q (p! a print)
Uj Signature ✓ Titlern
DOH-1555(o7/18)p t of z
I
I
Public Health Law Sec. 4145(2b) 013259
i
Receipt
Human remains of : .y delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#