Echols, Drew Lawrence NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Drew Lawrence Echols Male
Date of Death Age If Veteran of U.S.Armed Forces,
08/10/2021 76 Years War or Dates
1— Place of Death Hospital,Institution or
Ill
City,Town or Village Queensbury Town Street Address 38 Hillcrest Avenue,Queensbury Town,New York 12804
p Manner of Death '❑X Natural Cause ❑Accident 1=I Homicide El Suicide 0 Undetermined 0 Pending
W Circumstances Investigation
1.1rMedical Certifier Name Title
0 L Robert Love MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 165
Burial Date Cemetery,Crematory or Facility Name
08/12/2021 Pine View Crematory
Entombment Address
EICremation Queensbury Town,New York
Donation
ZO 0 Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
Q. Date Point of
U) ❑Transportation Shipment
Q by Common
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F. Remains are Shipped,If Other than Above
' Address
CC
W
4 Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/12/2021 Registrar of Vital Statistics Carolinexkiegarae Barher(Ekctronical61Signed)
(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:
Z 6-�--
W Date of Disposition g iilt i?,l Place of Disposition �t
2 (address)
141
CO
cc (section) /J (lot number) (grave number)
Q Name of Sexton or Person in Charge of Pre 'ses ////A ` 3k4 �
G3 pieafe print)
41 Signature Titl2e ( 1'
g
DOH-1555(07/18)p 1 of 2
1, 503E
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#