Hawkins, Stephen I3c
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Stephen Daniel Hawkins Male
Date of Death Age If Veteran of U.S. Armed Forces,
02/03/2018 72 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death Undetermined Pending
Natural Cause El Homicide ❑Suicide ❑ ❑
f _y!
Circumstances Investigation
Medical Certifier Name Title
Suzanne Rayeski DO
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 66
['Burial Date Cemetery or Crematory
02/09/2018 Pine View Crematory
['Entombment Address
®
Cremation Queensbury, New York
Date Place Removed
❑Removal and/or Held
and/or
Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
❑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
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/05/2018 Registrar of Vital Statistics Roden A Curtis(ECectronicaffySigned)
(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 2I 0ji( Place of Disposition
(address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Pre ises
(pl se print)
Signature LI Title
(over)
DOH-1555 (02/2004)