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Colvin Sr., Paul Raymond NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Paul Raymond Colvin Sr. Male Date of Death Age If Veteran of U.S.Armed Forces, 11/26/2021 75 Years War or Dates F. Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W n d et neenn W Manner of DeathU © Natural Cause El El Homicide Suicide ❑ ElPdi g Circumstances Investigation W Medical Certifier Name Title C3 Sean Bain MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number _ City,Town or Village Glens Falls 5601 544 ❑Burial Date Cemetery,Crematory or Facility Name 11/29/2021 Pine View Crematory ElEntombment Address Cremation Queensbury Town,New York ❑Donation ❑Removal Date Place Removed and/or and/or Held N Hold Address 0 (!�) ❑Transportation Date Point of by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address Date Cemetery Address ❑Reinterment Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom ▪ Remains are Shipped,If Other than Above 5 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/29/2021 Registrar of Vital Statistics WpbertAndrew Curtis(Electronically Signed) (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: F— / Z Date of Disposition //3Q TpZ/ Place of Disposition ,Je tJ-,�(,r/ er iq-7/G r[( 2 (address!_ W CC CC (section) (lot number)I (grave number) 0 Name of Sexton or Person in Charge o Premises '`�o Z (please print) LL Signature �1 Title UpT'� DOH-t555(o7/t8)p t of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 j--` Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#