Loading...
Turner Jr. Theodore �F. I60 "Town of Queensbury Certification of Cremation Pine View Cemetery and Crematory This certifies that the remains of: Theodore Turner Jr. were cremated on February 2 20 21 at the Pine View (Month) (Day) Crematorium, Queensbury, New York, and these are the cremated remains of said body. Date of Death January 26 20 21 Age 93 (Month) (Day) Funeral Home Singleton Sullivan Potter Registered No. 115 (Authorized Signature) P I1c NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Theodore Henry Turner Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, 01/26/2021 93 Years War or Dates Place of Death Hospital,Institution or Z W City,Town or Village Queensbury Town Street Address 196 Meadowbrook Road,Queensbury Town,New York 12804 p Manner of Death ©Natural Cause ❑Accident Homicide ❑Suicide Undetermined ❑Pending , Circumstances Investigation GMedical Certifier Name Title Mary Stein NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 34 ❑Burial Date Cemetery,Crematory or Facility Name 01/30/2021 Pine View Crematory ❑Entombment Address ElCremation Queensbury,New York ElDonation Z ❑Removal Date Place Removed and/or and/or Held , - Hold Address CA 0 CL(I) ❑Transportation Date Point of a by Common Shipment Carrier Destination El Disinterment Date Cemetery Address Date Cemetery Address ❑Reinterment 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 H Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/27/2021 Registrar of Vital Statistics Caroline 2fiCffegarde Barber(E(ectronica1ty 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 /n�Date of Disposition Zi Z 21 Place of Disposition IL if 0-- 2 (address) W CO (section) (lot"fiber) (grave number) SName of Sexton or Person in Charge of Pre ' es t., lt" S0t a in (please print) w tiVCA4 Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014 4 82 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# TURNER 017f) NAME Theodore Turner Jr. Age: 93 Lot Owner: Theodore and Margaret Turner Lot# Erie 17 G Grave# 2A Case: Urn Died: 1 /26/2021 Interred':/24/2021 Funeral Home: Singeleton Sullivan Potter Cemetery: Pine View