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Thew, Kenneth Daniel NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kenneth Daniel Thew Male Date of Death Age If Veteran of U.S.Armed Forces, 11/09/2020 50 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Mission Street,Glens Falls,New York 12801 1p Manner of Death ©Natural Cause Accident Homicide ElSuicide ElUndetermined ElPending Circumstances Investigation W Medical Certifier Name Title CI Timothy Murphy Coroner Address 52 HAVILAND AVE,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 514 ©Burial Date Cemetery,Crematory or Facility Name 11/16/2020 Pine View Cemetery ❑Entombment Address Cremation Queensbury Town,New York ❑Donation z 0— ElRemoval Date Place Removed and/or and/or Held - Hold Address 0 0. Date Point of U) ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 2 Address Q W CL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/13/2020 Registrar of Vital Statistics Wpbert Andrew Curtis(ECectronica/TySigned) (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: i— W Date of Disposition 11 /16/2020 Place of Disposition 21 Quaker Rd Queensbury, NY 12804 (address) N Wah-Ta-Wah 27 #693 (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises Connie Goedert (please print) W Signature Title Superintendent DOH-1555(o7/18)p t of 2 Public Health Law Sec. 4145(2b) 012820 Receipt Human remains of = . delivered on=;, , 20 �._ Pine View Cemetery "?.. _ Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# Thew NAME Kenneth Daniel Thew Age: 50 Lot Owner: Edwin & Ruth Winchip Lot# Wah-Ta-Wah sec.27 lot# 693 Grave# 5 Case: Concrete Died: Interred: 11 /9/2020 11 /16/2020 Funeral Home: Regan Denny Stafford Cemetery: Pine View WINCH!? Lot No. 693 LF►ddress Miller Hill N.Y. i Section No.27 )wner Edwin R. Winchip and Ruth C. Winchip Plot Wah-Ta-Wah )ate 8/8/57 200 Superficial ft. @ $1.30 per sq. ft. = $260.00 .ocation Bounded on n/e by Wier lot; on s/e by Dr. Haviland lot; on s/w by Pattor lot; on n/w by grass path :orner Posts remarks )eed No. (and changes) 693 'ayment Record Paid in full 8/8/57 $260.00 Form No. 01 Record of Interments 1 Robert W. Blowers (6/19/75) 5 Kenneth Daniel Thew DOD 1 1 /9/2020 yS scamc.- � ., 5 S-D5 6 I Edwin R. Winchip (3/17/81) 7 E Ruth E. Winchip 9/9/03 8 141 W ( 1V r 0 kl �i 2 3 4 5 6 z c x x ,\ k 'fir U f