Bell, Peter Edward /S�
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First '•Middle Last Sex
Peter Edward Bell Male
Date of Death Age If Veteran of . Armed Forces,
02/05/2021 60 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing
ui
'p Manner of Death rzgl
pal Natural Cause 0 Accident 0 Homicide El Suicide ❑Undetermined El Pending
Circumstances Investigation
Medical Certifier Name Title
0 Jennifer Donovan DO
Address
42 Gurney Ln,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 43
▪Burial Date Cemetery,Crematory or Facility Name
02/09/2021 Pine View Crematory
0 Entombment Address
0 Cremation Queensbury Town,New York
▪Donation
Z Removal• El
Date Place Removed
and/or and/or Held
~ Hold Address
N
0
O. Date Point of
co ❑Transportation
0 by Common Shipment
Carrier Destination
0 Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
2 Address
C
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/09/2021 Registrar of Vital Statistics CarolinexkfegarI Bar6er(Electronica*Signed)
(signature)
District Number 5657 Place Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
�,
,
W Date of Disposition IN� Place of Disposition tl
2 (ad ress)
W
N (section) (lo umber) (grave number)
O Name of Sexton or Person in Charge of Premises f'x �' 'v`)1
(please pr t)
fW Signature Title GYLY`Mpf
�7�
DOH-1555(07/18)p i of 2
L_ :r
Public Health Law Sec. 4145(2b) 01 4 E`
Receipt
Human remains of delivered on , 20 •
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#