Loading...
Pinchook, Stephen Wiliam NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Stephen William Pinchook Male Date of Death Age If Veteran of U.S.Armed Forces, 06/22/2021 71 Years War or Dates p. Place of Death Hospital,Institution or Ill City,Town or Village Queensbury Town Street Address 60 Walker Lane,Queensbury Town,New York 12804 a Manner of Death ©Natural Cause ❑Accident ❑Homicide El Suicide ❑Undetermined El Pending 11.1 U Circumstances Investigation IJJ C Medical Certifier Name Title Anne Evans DO Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 131 ©Burial Date Cemetery,Crematory or Facility Name 06/25/2021 Pine View Cemetery ❑Entombment Address ❑Cremation Queensbury,New York ElDonation Z Removal Date Place Removed and/or and/or Held ~ Hold Address CO 0 II. Date Point of N 1-1 Transportation p by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address 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 t Remains are Shipped,If Other than Above g Address CC O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/25/2021 Registrar of Vital Statistics Caroline Hfi(degarcre Barber(E(ectronicafy 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: I— W Date of Disposition 6/2 5/2 0 21 Place of Disposition 21 Quaker Rd Queensbury, NY 12804 (address) W Erie 45 D 1 N (section) (lot number) (grave number) 8 Name of Sext or Person in ChargO'remises Connie Goedert (please print) W Signature Aitit.l.[, ,_ C'D Title Superintendent DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) 012861 1 Receipt fiI Human remains of , `' ti `-'ry Y t ; s delivered on , 20 21 r / i Pine View'em tery Representing the funeral home named on burial permit I ( Official Funeral Directors Reg.or License# , ~ -I 't f PINCHOOK NAME Stephen William Pinchook Age: 71 Lot Owner: Stephen W. Pinchook Lot# Erie 45 D Grave# 1 Case: Concrete Died: 6/2 2/2 0 21 Interred: 6/2 5/2 0 21 Funeral Home: Singleton Sullivan Potter Cemetery: Pine View