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O'Rourke, Dennis Patrick -it j3s NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Dennis Patrick O'Rourke Male Date of Death Age If Veteran of U.S.Armed Forces, 02/09/2022 70 Years War or Dates 1974-1976 F. Place of Death Hospital,Institution or Z City,Town or Villa Glens Falls Street Address Glens Falls Hospital pManner of Death ©Natural Cause Accident 0 Homicide 0 Suicide El Undetermined ElPending V Circumstances Investigation Q Medical Certifier Name Title Marvin Davidowitz MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 93 0 Burial Date Cemetery,Crematory or Facility Name 02/10/2022 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held ~ N Hold Address 0 O. Date Point of U) ❑Transportation 5 by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom —. Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/10/2022 Registrar of Vital Statistics Megan Nofin(ECectronica1Ty 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: WDate of Disposition o?/2—Z.0Z L. Place of Disposition �� ,J e v.`e„J 2 (address) W LC (section) D (lot number) (grave number) gName of Sexton or Person in Charge of P emises PY mop✓ 6 GVftob Z (please print) W Signature Title Of redo(— DOH-1555(07/18)p 1 of 2 f ,) yr)4.4,. Public Health Law Sec. 4145(2b) Receipt IHuman remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#