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Daniel, Donald L. NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Donald F.Daniel Male Date of Death Age If Veteran of U.S.Armed Forces, 02/18/2021 67 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Hadley Town Street Address 3907 N Shore Road, Hadley Town, New York 12835 w Manner of Death Pending G ©Natural Cause �Accident �Homicide �Suicide �Undetermined � W V Circumstances Investigation W Medical Certifier Name Title CI John Mongan DO Address 3 Care Lane,Saratoga Springs, New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Hadley 4558 4 ❑Burial Date Cemetery,Crematory or Facility Name 02/19/2021 Pine View Crematory Entombment Address ElCremation Queensbury Town,New York ❑Donation IS Removal Date Place Removed and/or and/or Held - Hold Address O Lt. Date Point of t/) j Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address ❑Reinterment Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500, Lake Luzerne, New York 12846 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 2 Address CC W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/19/2021 Registrar of Vital Statistics Pauline G Smead(Electronically Signed) (signature) District Number 4558 Place Hadley, 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 07-,2D- ,1) Place of Disposition R-;JL i% C,C/n !` 2 (address) W CC (section) �� 9 (lot number) (grave number) 0 Name of Sexton or Person in arge of Premi 1Y1�to')� �' �%�6 O 44 (please print) W Signature �fif /V� Title UrC'-1-4441 DOH-1555(o7/18)p t of 2 • Public Health Law Sec. 4145(2b) 314 5 6 3 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#