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Howlett, John Stirling NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John Stirling Howlett Male Date of Death Age If Veteran of U.S.Armed Forces, 10/10/2021 80 Years War or Dates t Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 104 Hunter Lane,Queensbury Town, New York 12804 0 Manner of Death © Natural Cause ❑Accident 0 Homicide ❑Suicide ❑Undetermined El Pending IIJ Circumstances Investigation WMedical Certifier Name Title 0 David Cunningham MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 207 Burial Date Cemetery,Crematory or Facility Name 10/12/2021 Pine View Crematory ❑Entombment Address 0 Cremation Queensbury,New York ❑Donation Z ❑Removal Date Place Removed and/or and/or Held F- Hold Address (0 0 0. Date Point of (I) Li Transportation 0 by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address IDReinterment 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 IRemains are Shipped,If Other than Above Address CC O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/12/2021 Registrar of Vital Statistics Caroline 9fi1fegarie Barber(ECectronicaliy 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: Date of Disposition /0—l3-1 op Place of Disposition P/yJQ t/,'ej e—ls,.yi 418,14Al IU 2 /address/ W 1 (section) 1 (lot number) (grave number) SName of Sexton or Per in Charge of Premises 3t"1t•-n Ge- i.e. Z / (please print)ILI // Signature j./i.,.._ Title G/tm41,7 p�P., s/ DOH-1555(07/18 p 1 of 2 Public Health Law Sec. 4145(2b) 1 Receipt Human remains of ! delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit ' Official Funeral Directors Reg.or License# t