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Doran, Donald Ernest A 7q NEW YORKSTATE DEPARTMENT OF HEALTH r Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Donald Ernest Doran Male Date of Death Age If Veteran of U.S.Armed Forces, 03/04/2020 77 Years War or Dates Place of Death Hospital,Institution or City,Town or Village Glens Falls Street Address Glens Falls Hospital Mannerof Death © ❑Undetermined Pending Natural Cause Accident Homicide Suicide Circumstances Investigation Medical Certifier Name Title Paul Filion MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town orViRage Glens Falls 5601 115 µ Burial Date Cemetery,Crematory or Facility Name 03/09/2020 Pine View Crematory Entombment Address ;. Cremation Queensbury Town,New York c ❑Donation Removal Date Place Removed and/or and/or Held ,as 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-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address W 14 Permission is hereby granted to dispose of the human remains described above as indicated. K Date Issued 03/09/2020 Registrar of Vital Statistics WpbertAndrew Curtis(ECectronically Signed (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 lc),;L Place of Disposition ; Lf krY (address) (section/ (tot number) (grave number) Name of Sexton or Person in Charge of Premises f mSQ l,lirc (please print) Signature t Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 i (1 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#