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Glennie,Douglas Charles NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Douglas Charles Glennie Male Date of Death Age �Ifeteran of U.S.Armed Forces, 03/13/2020 47 Yearsar or Dates Place of Death Hospital,Institution or WCity,Town or Village Warrensburg Town Street Address W State Route 9,Warrensburg Town, New York 12885 pManner of Death Natural Cause Accident Homicide Suicide Undetermined Pending U Circumstances Investigation WD Medical Certifier Name Title Lynn Keil Address 1340 State Route 9, Lake George Town, New York 12845 Death Certificate Filed District Number Register Number City,Town or Village Warrensburg 5660 5 ©Burial Date Cemetery,Crematory or Facility Name 03/19/2020 Pine View Cemetery Entombment Address ❑Cremation Queensbury Town,New York Donation OZ Removal Date Place Removed and/or and/or Held i—N Hold Address O d Date Point of U) FiTransportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom f.. Remains are Shipped,If Other than Above Address Q W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/16/2020 Registrar of Vital Statistics PamelaMZ,lavd(ElectrnnicalySone4 (signature) District Number 5660 Place Warrensburg, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H W Date of Disposition 3/19/2 02 0 Place of Disposition 21 Quaker Rd. ueensbur 2 (address w Seneca 34H 1 CO) lZ (section) (lot number) (grave number) j3Name of Sext or Person in Charge of Premises Connie Goedert Z r (plea=1111,41T'1� W Signature Title I III DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 010377 Receipt Human remains of delivered on ` , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# Glennie NAME Age: Douglas Charles Glennie 47 Lot Owner: Nicole Glennie Lot# 3 4H Seneca Grave# 1 Case: Concrete Died: 3/1 3/2 0 2 0 Interred:3/1 9/2 0 2 0 Funeral Home: Baker Cemetery: pine View GLENNIE Owner Nicole Cl Pnni c Address Plot 16 Sweetbriar Lane NV 11804 RPneca Phone # Lot # 518-955-6689 3AH Deed # Date #41 tiR 3/1 6/2020 Cost Foundation Y - N $650 00 Location North- Woods South- Vacant West- Roadway East- Schmidt Remarks I ACKNOWLEDGE THE RECEIPT OF THE RULES AND REGULATIONS OF PINE VIEW CEMETERY. SIGNATURE. DATE: J ` Record of Interments 1 6 Doi,gla. rziannio 3/13/2020 2 7 3 8 4 9 5 10 s � N a w w C, S