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Winchip Jr., Edwin Robinson j—F NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Edwin Robinson Winchip Jr Male Date of Death Age If Veteran of U.S.Armed Forces, 09/21/2021 81 Years War or Dates Navy Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 4 Waverly Place,Queensbury Town, New York 12804 p Manner of Death © Natural Cause Accident El Homicide Ei Suicide ID Undetermined 0 Pending W Circumstances Investigation WMedical Certifier Name Title CI Robert Reeves MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 197 ©Burial Date Cemetery,Crematory or Facility Name 09/24/2021 Pine View Cemetery ElEntombment Address ElCremation Queensbury,New York ❑Donation ZO ❑Removal Date Place Removed F and/or and/or Held N Hold Address N ❑Transportation Date Point of S by Common Shipment Carrier Destination El 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 2 Address tl ILLI a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/23/2021 Registrar of Vital Statistics Caroline 2fifiegarte Barber(ECectronicaffy 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: Z W Date of Disposition 9/24/21 Place of Disposition 21 Quaker Rd, Queen Ghury, my 12804 2 (address` W Oneida 17+20 2 cc (section) (lot number) (grave number) S Name of Sexto Person in Charge of Premises Connie Goedert �O (please print) W Rita, f... Title Superintendent Signature DOH-1555(07/18)p i of 2 WINCHIP r LF NAME Edwin Roninson WinchipAge 81 Lot Owner: Robert A Dumas & Janice M Lamb Lot# Onieda 17 + 20 Grave# 2 Case: Concrete Died: 9/21 /21 Interred: 9/2 4/21 FuneralHome:Singleton Sullivan Potter Cemetery: pine View Lot-No. 7sQ0 Address Box 116 11, Schuylerville, N.Y. Section No. Owner Robert A.) nas & Janice f Lamb Plot Oneida 1,0ti nc\-)‘ Date- . i:1/llt/78 1140 Superficial ft. @ $2.50 per sq. ft. Location Boded on the North by Vacant, East by Vacant, South by Path & Matteson, West by Road Corner Posts Remarks Deed No. (and changes) 1510 Payment Record Paid in full 11/i►1/78 . Form No. 01 Record of Interments 1. 9i51niTcl•t-c-d F'I-or� Ranrdy 4.awtb '-S- -6R 1r-o- tietJedSAnt Ytl2 /co-i.s-9I We ,n��r.r=rt 3 I --r C]RGi e., 1!i\t V,s j,`- I-a� >fi , 1 11*doll 4 - Robert A. Dumas 9/28/91 181 v d /, le- / ,.../.___, ,...___ 4 ?..‹. '. )( IC-, ,.: [1] 175 'Y' -') ,... --i 1 ° i _1 l 1 I CAP