Whitman Jr., Donald Thomas NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Donald Thomas Whitman Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
08/27/2021 45 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Albany Street Address Albany Medical Center Hospital
W
pManner of Death Natural Cause Accident ❑Homicide El Suicide ❑Undetermined Pending
U Circumstances Investigation
W Medical Certifier Name Title
O Rick Mclaughlin PA
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 2123
▪Burial Date Cemetery,Crematory or Facility Name
08/30/2021 Pine View Crematory
❑Entombment Address
lCremation Queensbury Town,New York
❑Donation
• ElRemoval Date Place Removed
and/or and/or Held
H Hold Address
0
O. Date Point of
f/) ❑Transportation
p by Common Shipment
Carrier Destination
0 Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
2 Address
CC
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/30/2021 Registrar of Vital Statistics Danielle S Gillespie(Electronically Signed)
(signature)
District Number 0101 Place Albany, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z a,.W Date of Disposition g)301"Li Place of Disposition �
address
W
N
CC (section) 4 (1?!number) (grave number)
S Name of Sexton or Person in Charge of Pr ' s
(plea e prin>441...AK
W Signature yG_ Title
CIWAAIfpit
DOH-1555(07/18)p t of 2
r
Public Health Law Sec. 4145(2b) 09
Receipt
Human remains of • ` ' delivered on , 20
1
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#