Stowell, Roderick S _ , `g 5-7
NEW YORK STATE DEPARTMENT OF HEALTH Burial- Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Roderick S Stowell Male
Date of Death Age If Veteran of US.Armed Forces,
10/10/2021 89 Years War or Dates 1952-1956
H
Place of Death Hospital.Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
UJ
• Manner of Death Natural Cause El Accident 0 Homicide El Suicide El Undetermined El Pending
✓ Circumstances Investigation
G Medical Certifier Name Title
Julian Marynczak PA
Address
100 Park St.Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 445
121 Burial Date Cemetery,Crematory or Facility Name
10/13/2021 Pine View Crematory
Ej Entombment Address
aCremation Queensbury Town,New York
Donation
OZ❑Removal Date Place Removed
and/or and/or Held
N Hold Address
0
O. Date Point of
N ❑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 Edward L Kelly Funeral Home 00519
Address
PO Box 548,Schroon Lake,New York 12870
Name of Funeral Firm Making Disposition or to Whom
I—. Remains are Shipped,If Other than Above
▪ Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/12/2021 Registrar of Vital Statistics RdiertAndrewCu#u'(ketro,rea .Sitne4
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition /0—/4/-749y/ Place of Disposition J7r)1 ev f) /!g 4-241ay
2 /address) /
W
N CC (section) (lot tuber) (grave number)
/
S Name of Sexton or Person' Charge of Premises ,~!t Gi/t I#1 .
(please print)
W Signature 1/.1i Title "1.1 U�
DOH-1555(07/18)p 1 f 2 /
ti I ` 224
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#