Labins, DonaldNEW YORKSTATE DEPARTMENT OF HEALTH
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Bureau of Vital Records urea - ransit Permit
Name First Middle Last
Sex
Donald Joseph Labins
Male
Date of Death
Age
If Veteran of U.S. Armed Forces,
10/23/2019
59 Years
War or Dates
_ Place of Death
Hospital, Institution or
V City, Town or Village Glens Falls
Street Address Glens Falls Hospital
a Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending
jLnj Circumstances Investigation
Medical Certifier Name Title
Gamal Khalifa MD
Address
100 Park St, Glens Falls, New York 12801
Death Certificate Filed
District Number
Register Number
City, Town or Village Glens Falls
5601
463
Burial
Date
Cemetery, Crematory or Facility Name
Entombment
10/24/2019
Pine View Crematory
Address
Cremation
Queensbury Town, New York
Donation
Removal
Date
Place Removed
and/or
and/or Held
Hold
Address
Transportation
Date
Point of
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
Remains are Shipped, If Other than Above
Address
I
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/24/2019 Registrar of Vital Statistics .�6ert,7ndrewC du�E'lectronicaf 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:
Date of Disposition /a ith III Place of Disposition
(address)
(sed/on) (l number) (gravenumber)
Name of Sexton or Person in Charge of Premises / Z t tT
(please Tint)
Signature Title
DO H-1555 (07/18) p 1 of 2
Public Health Law Sec. 4145(2b)
13020
Receipt
Human remains of
delivered on
,20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License # '