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Parker, Donald John NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Donald John Parker Male Date of Death Age If Veteran of U.S.Armed Forces, 01/28/2022 76 Years War or Dates 1966-1968 Place of Death Hospital,Institution or Z City,Town or Village Granville Town Street Address Slate Valley Center for Rehabilitation and Nursing 'p Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending 0 Circumstances Investigation G Medical Certifier Name Title Joshua Starteri NP Address 10421 State Route 40,Granville Town,New York 12832 Death Certificate Filed District Number Register Number City,Town or Village Granville 5756 7 ❑Burial Date Cemetery,Crematory or Facility Name 02/03/2022 Pine View Crematory ❑Entombment Address aCremation Queensbury Town,New York ❑Donation gRemoval Date Place Removed and/or and/or Held - Hold Address 0 0. Date Point of U! ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom I— Remains are Shipped,If Other than Above 2 Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/31/2022 Registrar of Vital Statistics Jenny Linda M Marte((e(E(ectronicaCCy Signed) /signature/ District Number 5756 Place Granville, 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 y - Place of Disposition ��f� y L,y/ Cl1'e,M(/l'o y /dr s/ W N (section) (lot number) (grave number) gName of Sexton or P r on in harge of Premises -3-c.5At, ' , TLS (lease print) W Signature s�T- Title Ca,ii2 t"i0 a f v DOH-1555(07 p 1 of 2 015L!,i5 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#