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Crowe, Richard Wiliam
it Oil NW 4(ORKSTATE DEPARTMENT OF HEALTH Burial - Transit Pe It Bureau of Vital Records Name First Middle Last Sex Richard William Crowe Male Date of Death Age If Veteran of U.S.Armed Forces, 08/12/2021 73 Years War or Dates Army f,. Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 19 Jay Road West,Queensbury Town, New York 12845 p Manner of Death ©Natural Cause 0 Accident Ei Homicide 0 Suicide Undetermined 0 Pending W Circumstances Investigation W Medical Certifier Name Title G Ageel Gillani MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 168 IDBurial Date Cemetery,Crematory or Facility Name 08/13/2021 Pine View Crematory 0 Entombment Address ElCremation Queensbury,New York 0 Donation Z 0 Removal Date Place Removed and/or and/or Held N Hold Address 0 Date Point of N L j Transportation Shipment p by Common Carrier Destination 0 Disinterment Date Cemetery Address Date Cemetery Address ElReinterment 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 F. Remains are Shipped,If Other than Above 2 Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/13/2021 Registrar of Vital Statistics Caroline gadegarde Barber(ElectronicalTy Signed) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance�wiith this permit on: W Date of Disposition g i i/'�D.�I Place of Disposition j"7, % .J� -I►'eve (address) tma-J t JJ W NCC (section) (lot number) (grave number) �y f SName of Sexton or Person in Charge o remi s O "B'� (I E`0 b a Z ) please print) W Signature ` / 1/ / Title v DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on_ , 20 Pine View CemeteryRepresenting the funeral home named on burial permit Official Funeral Directors Reg.or License#