Mabb Sr., Joseph F. » ., /030
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Joseph F.Mabb Sr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/30/2021 75 Years War or Dates
1— Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
tp Manner of Death ❑X Natural Cause ❑Accident ❑Homicide ❑Suicide ElUndetermined El Pending
U Circumstances Investigation
W Medical Certifier Name Title
G Mathew Varughese DO
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 556
Burial Date Cemetery,Crematory or Facility Name
12/06/2021 Pine View Crematory
Entombment Address
X❑Cremation Queensbury,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
N Hold Address
0
a 1-1 Date Point of
to ❑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
F— Remains are Shipped,If Other than Above
2 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/01/2021 Registrar of Vital Statistics Rp6ert�?udrew Curtis(Ekctrnnrcag;Signer!)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in rdance with this permit on:
Z Date of Disposition J2'04.-7liZ/Place of Disposition 6/+'t
W
(address)
W
Q (section) l (lot n mber) (grave number)
GName of Sexton or Perso iu Ch a of P s ` f� ✓t
Z (pi a print)
W Signature Title G �``'✓!'r� Y 2 �� i/
DOH-1555(07/18)p id 2
015406
Public Health Law Sec. 4145(2b)
Receipt
li
Human remains of delivered on , 20
1 9
r
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License