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Plowman, David Gray
-71 /go NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex David Gray Plowman Male Date of Death Age If Veteran of U.S.Armed Forces, 11/15/2021 73 Years War or Dates Air Force Place of Death Hospital,Institution or Z City,Town or Village Albany Street Address Albany Medical Center Hospital IJJ p Manner of Death ©Natural Cause n Accident ❑Homicide 1=1 Suicide EUndetermined ❑Pending (W) Circumstances Investigation G Medical Certifier Name Title Amit Shetty DO Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 2828 Burial Date Cemetery,Crematory or Facility Name 11/18/2021 Pine View Crematory ❑Entombment Address — aCremation Queensbury,New York ❑Donation Z, Date Place Removed ci n Removal H and/or and/or Held N Hold Address 0 IL Date Point of U) Li Transportation p by Common Shipment Carrier Destination 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 t- Remains are Shipped,If Other than Above ,$ Address Cle O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/18/2021 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: W Date of Disposition III 11 It' Place of Disposition i� V� /� ori,.._. 2 (address) W Q (section) / (lot number) number/ + #1.1 4;% Z lease print) I!J Signature Title ry DOH-1555(07/18)p 1 of 2 3.153 '7 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#