Huntley, David Paul NEW YORK STATE DEPARTMENT OF HEALTH Burlal - Transit Permit
Bureau of Vital Records
Name First Middle _ Last Sex
David Paul Huntley Male
Date of Death Age If Veteran of U.S.Armed Forces,
05/14/2020 56 Years War or Dates UNKNOWN
ZPlace of Death Hospital,Institution or
LU City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death Natural Cause Accident Homicide ❑Suicide Undetermined Pending
0 Circumstances Investigation
WQ Medical Certifier Name Title
Marvin Davidowitz MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 222
Burial Date Cemetery,Crematory or Facility Name
05/19/2020 Pine View Crematory
Entombment Address
0 Cremation Queensbury Town,New York
Donation
Z Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
O
ILL Date Point of
0 Transportation
p by Common Shipment
Carrier Destination
El 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
H Remains are Shipped,If Other than Above
g Address
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/19/2020 Registrar of Vital Statistics .W,&.J1 rewC-rtxr(EkctronkalfjySoned)
(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:
F—
Z Date of Disposition S121D 1 to Place of Disposition ,P
�. (address)
w
U)
If r (section) (lot number) c (grave number)
aName of Sexton or Person in Charge of Premises G' ►`r► L— J,a--A
Z 01 se print)
LU Signature /,r— Title 14116TK
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) Q 13 L'�2-
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#