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Powers, Stephen F. NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permi Bureau of Vital Records Name First Middle Last Sex Stephen F Powers Male Date of Death Age If Veteran of U.S.Armed Forces, 09/28/2020 83 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Granville Town Street Address Slate Valley Center for Rehabilitation and Nursing W• Manner of Death © ❑ Undetermined ❑Pending Cause Accident Homicide Suicide W Circumstances Investigation ui Medical Certifier Name Title G Leonard Gelman MD Address 10421 State Route 40,Granville Town,New York 12832 Death Certificate Filed District Number Register Number City,Town or Village Granville 5756 62 ▪Burial Date Cemetery,Crematory or Facility Name 10/01/2020 Pine View Crematory Entombment Address lCremation Queensbury Town,New York ❑Donation o• ElRemoval Date Place Removed and/or and/or Held H Hold Address N 0 O. Date Point of ❑ co Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom -. Remains are Shipped,If Other than Above g Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/01/2020 Registrar of Vital Statistics Jenny Linda Martetfe(E(ectronica((y Signed) (signature) District Number 5756 Place Granville, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition p I 1 J7p Place of Disposition (address) IW N (section) 4 (lot number) (grave number) Name of Sexton or Person in Charge of mises rwt p�-- �i»•�If'f (prase print) W Signature Title (4.1,)K. DOH-1555(07/18)p 1 of 2 01.4063 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#