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Sokol, Donald John NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Donald John Sokol Male Date of Death Age If Veteran of U.S.Armed Forces, 04/14/2020 79 Years War or Dates Army Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 38 Helen Drive,Queensbury Town,New York 12804 p Manner of Death ©Natural Cause Accident Homicide ❑Suicide Undetermined Pending (Wj Circumstances Investigation WC1 Medical Certifier Name Title Robert Love MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 68 Burial Date Cemetery,Crematory or Facility Name 04/15/2020 Pine View Crematory Entombment Address 0 Cremation Queensbury,New York Donation 0 Removal Date Place Removed and/or and/or Held t= Hold Address N O NTransportation Date Point of jS by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 101443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 2 Address Q W n' Permission is hergby granted to dispose of the human remains described above as indicated. Date Issued 04/15/2020 Registrar of Vital Statistics CarohneWildegarde Barber(ECectronicalTySigned) (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 yl'n ►ZO Place of Disposition 2. 1L r, Uj (address) W Q (section) (lot number) (grave number)l Name of Sexton or Person in Charge of Pr mises 11 r� T Z (plAkseprom, W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) C 13 5 4 t Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#