Towers, Donald NEW YORK STATE DEPARTMENT OF HEALTH
' if 70g
Vital Records Section Burial - Transit Permit
Name . First Middle Last Sex
VAI Donald A.Towers Male
51 Date of Death Age If Veteran of U.S. Armed Forces,
09/18/2017 84 Years War or Dates 1950-54
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death Natural Cause❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
'° , Circumstances Investigation
Medical Certifier Name Title
M Farhana Kama! MD
LA Address
100 Park St,Glens Falls,New York 12801
• Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 493
❑Burial Date Cemetery or Crematory
09/21/2017 Pineview Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
°fr'' Date Place Removed
❑• Removal and/or Held
and/or Address
Hold
Date
,, Li Transportation
•
- by Common Destination
iv,,,nf; Carrier
Am,
■ Disinterment Date Ty Address
tv4❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
, Name of Funeral Home Densmore Funeral Home Inc 00448
y, Address,
4 , 7 Sherman Ave,Corinth,New York 12822
O Name of Funeral Firm Making Disposition or to Whom
, Remains are Shipped, If Other than Above
L. Address
Permission is hereby granted to dispose of the human remains described above as indicated.
ti
Date Issued 09/20/2017 Registrar of Vital Statistics W9fiert ACurtis E ctronuaaysigned-
(signature)
Mi District Number 5601 Place Glens Falls, New York
ii
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition (jJ 1t I n Place of Disposition f LUy,✓ gr.tvtar i...i
" (address)
•--
(section) (tot number) (grave number)
,? Name of Sexton or Person in Charge of Pr ises S 'i'tt
,I (pie a print)
Signature Gt Title azoor
(over)
DOH-1555(02/2004)