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Dumas Stephen Alexander
if 301 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Stephen Alexander Dumas Male Date of Death Age If Veteran of U.S.Armed Forces, 03/28/2021 62 Years War or Dates Place of Death Hospital,Institution or City,Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death ©Natural Cause El Accident El Homicide D Suicide 0 Undetermined ❑Pending W a Circumstances Investigation W Medical Certifier Name Title a Sean Bain MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 160 ❑Burial Date Cemetery,Crematory or Facility Name 03/30/2021 Pine View Crematory ❑Entombment — Address 0 Cremation Queensbury,New York El Donation 4 Z ate Place Removed 0 El Removal and/or Held pand/or N Hold Address Date Point of to ❑Transportation Shipment a by Common Carrier Destination Date Cemetery Address ❑Disinterment 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 ,i.. Remains are Shipped,If Other than Above S Address IrC l! Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/30/2021 Registrar of Vital Statistics q?p6ertAndrew Curtis(Electronically Signed) (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: 1 Date of Disposition 31301 Z1 Place of Disposition ..jL2 (as7 ill o.-_ W CC (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premises t~f L „Svvv.t 1 /tease pm 0L "�tT � IU Signature _ Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) iI 4 5 7 Receipt Human remains of v delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#