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Depew, David Allen
�)Iz NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex David Allen Depew Male Date of Death Age If Veteran of U.S.Armed Forces, 03/23/2020 71 Years War or Dates 1965-1968 Place of Death Hospital,Institution or Z' City,Town or Village Glens Falls Street Address Glens Falls Hospital „i0 Manner of Death ©Natural Cause ❑Accident 0 Homicide ❑Suicide �Undetermined �Pending V Circumstances Investigation W Medical Certifier Name Title G Marvin Davidowitz MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number 7Register Number City,Town or Village Glens Falls 5601 ❑Burial Date Cemetery,Crematory or Facility Name 03/26/2020 Pine View Crematory Entombment Address Cremation Queensbury Town,New York Donation Z Date Place Removed 0 ❑Removal P and/or and/or Held U Hold Address 0 I' Date Point of t/a❑Transportation p 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-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom F Remains are Shipped,If Other than Above Address W' IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/25/2020 Registrar of Vital Statistics Wpbert,4ndrew 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: ZDate of Disposition Place of Disposition Yl� g /address) W: M /section) /!ot number) /gra ve number) 0 Name of Sexton or Person in Cha of PZ�s D Z /please print) W ol Signature Title DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 013460. Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# i i i i i