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Edmunds, Donald Stanley - NEW YORKSTATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Pe mit Name First Middle Last Sex Donald Stanley Edmunds Male Date of Death Age If Veteran of U.S.Armed Forces, 07/13/2021 86 Years War or Dates Army Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address 9 North Road,Glens Falls,New York 12801 Manner of Death Undetermined Pending W ©Natural Cause Accident �Homicide �Suicide U Circumstances Investigation W 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 Glens Falls 5601 289 Burial Date Cemetery,Crematory or Facility Name 07/15/2021 Pine View Crematory Entombment Address lCremation Queensbury,New York ❑Donation 0 El Removal Date Place Removed and/or and/or Held N Hold Address 0 a Date Point of (Aj Transportation Shipment p by Common 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 Remains are Shipped,If Other than Above _► Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/15/2021 Registrar of Vital Statistics Men Andrew Curtis(ECectronica1TySigned) (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: ~ �� tff W Date of Disposition 7�!�� � Place of Disposition i+u +�— �--- 2 (address) W N (section) (lot number) (grave number) Name of Sexton or Person in Cha of Premises Z G-✓' (Pi se print) � W Signature Title ( "' t�c DOH-1555(07/18)p i of 2 s. a, Public Health Law Sec. 4145(2b) 014947 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#