Carlson, Donald Edward " WL
NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Donald Edward Carlson Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/15/2020 88 Years War or Dates 1954-1956
Place of Death Hospital,Institution or
WCity,Town or Village Queensbury Town Street Address The Stanton Nursing And Rehabilitation Centre
p Manner of Death 91 Natural Cause Accident Homicide ❑Suicide Undetermined Pending
(Wj Circumstances Investigation
QW Medical Certifier Name Title
Wendy Steinhacker PA
Address
152 Sherman Ave,Queensbury Town,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 71
Burial Date Cemetery,Crematory or Facility Name
04/17/2020 Pine View Crematory
Entombment Address
x Cremation Queensbury Town,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
H N Hold Address
O
d Date Point of
N Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 700364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
ir
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/16/2020 Registrar of Vital Statistics Carorne-Zi,;9--yarde Bader(EYetronicad So-d)
(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:
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Z Date of Disposition Place of Disposition OL 60 Ctd...
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2 (address/
W
N
w (section/ (lot number) (grave number)
0 Name of Sexton or Person in Charge Premises t /4
Z (ple a prm
W Signature Title l ✓�
DO H-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 0 ? 5 5 e' 4
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Receipt
Human remains of delivered on , 20_
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Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#