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Donovan, Richard NEW YORK STATE DEPARTMENT OF HEALTH �ticl Vital Records Section Burial - Transit Permit Name First Middle Last 1 Sex Richard J. Donovan Male Date of Death Age If Veteran of U.S. Armed Forces, July 10,2011 _ 63 War or Dates H Place of Death Hospital, Institution or Z City, Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death n Natural Cause n Accident —_Homicide n Suicide Undetermined Pending W Circumstances Investigation w Medical Certifier Name Title 0 Joseph Mihindu MD Address 20 Murray Street,Glens Falls NY °::, Death Certificate Filed 1 District Number Register Number City, Town or Village Glens Falls 5601 I 3 oci ❑Burial Date Cemetery or Crematory July 12, 2011 Pine View Crematorium ❑Entombment Address ©Cremation 21 Quaker Road, Queensbury,NY 12804 Date Place Removed Z l I Removal and/or Held and/or Address F' Hold N o Date Point of NTransportation Shipment a by Common Destination Carrier n Disinterment Date Cemetery Address I I Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan& Denny Funeral Home 01464 _ Address :' 53 Quaker Road, Queensbury, NY 12804 .' Name of Funeral Firm Making Disposition or to Whom l- Remains are Shipped, If Other than Above Address i 12- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 7/1 2-1 // Registrar of Vital Statistics (-AA .... Z (signatur ) District Number 5 HD l Place U.4- `S rck.U .S U 7 r I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition ). Ilt(11 Place of Disposition ,ny i/ v i c(.► it.. 2 (address) W N et (section) /�l T lot number)/^ (grave number) pName of Sexton or Pers in Charge of Premises t I r o{ Oe,Artit ZL (please print) W Signature Title Can MO°V' - (over) DOH-1555(02/2004)