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Slater, Donald Mark
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex .' Donald Mark Slater Male 4'' Date of Death Age If Veteran of U.S.Armed Forces, 03/02/2020 85 Years War or Dates Place of Death Hospital,Institution or City,Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death © Natural Cause Accident ❑Homicide Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 108 QBurial Date Cemetery,Crematory or Facility Name 03/05/2020 Pine View Crematory ❑Entombment Address QCremation Queensbury Town,New York Donation Z �Removal Date Place Removed � and/or and/or Held _ ~ Hold Address 0 Transportation Date Point of by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/05/2020 Registrar of Vital Statistics 9�gben gndrew Curtis(ElectronicalTySiyner) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 3 is/1-O)- ace Place of Disposition i C'(L, y (address) (section) (lot number) (grave number) Name of Sexton or Person in Charg Premises Tf t s U,ris Z (please print) Signature Title F DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) JAI 013390 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#