Sexton, Donald NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
iiiiii Name First _ Middle Last Sex
Donald Edward Sexton Male
iig Date of Death Age If Veteran of U.S. Armed Forces,
February 27, 2015 78 War or Dates Army
i:.: Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
gi Manner of Death X Natural Cause Accident I I Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
iM Marvin Davidowitz,MD
Address
100 Park Street,Glens Falls,NY 12801
Death Certificate Filed District Number Regist9r.f lumber
City, Town or Village Glens Falls,NY 5601 /f/
. ❑Burial Date Cemetery or Crematory
March 2, 2015 Pine View Crematorium
Ill Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
co
0 Date Point of
N1 I Transportation Shipment
Q by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
iii Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Home 01444� Address
�m 94 Saratoga Avenue, South Glens Falls, NY 12803
Name of Funeral Firm Making Disposition or to Whom
(,:+ Remains are Shipped, If Other than Above
B Address
' :'. Permission is hereby granted to dispose of the human remains described above as indicated.
E Date Issued 3) 2`/5 Registrar of Vital Statistics ��
'?: Oil (signature)
V
District Number 5601 Place Glens Falls,NY �0
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z W Date of Disposition 3)yf jy- Place of Disposition 4U �*+-c7 1dr.,,,i
Ili (address)
CO
CL
(section) (lot nu�'(�r) (grave number)
p Name of Sexton or Person in Charge of Premises t�, e.Jti'�
Z (please print)
W
Signature L Title (4.► t
(over)
DOH-1555(02/2004)