Linn, Peter Robert It 237
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Peter Robert Linn Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/14/2022 66 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 4 Elk Ridge Drive,Queensbury Town,New York 12804
UJ
p Manner of Death E1 Natural Cause IllAccident ❑Homicide Suicide nUndetermined riPending
UJ
Circumstances Investigation
U
W Medical Certifier Name Title
C Aqeel Gillani MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 52
Burial Date Cemetery,Crematory or Facility Name
03/15/2022 Pine View Crematory
Entombment Address
Cremation Queensbury,New York
Donation
ZOORemoval Date Place Removed
and/or and/or Held
H Hold Address
CO
0
O. Date Point of
U)❑Transportation Shipment
p by Common
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
(.. Remains are Shipped,If Other than Above
a Address
Q
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/15/2022 Registrar of Vital Statistics Caroline x((egarIe Barber(ECectronica(TySigned)
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IH � i
Z Date of Disposition 3/11#1 n Place of Disposition 1 1,,, .__
W (address)
W
N r� (section) (lot number/ (grave number)
C
Name of Sexton or Person in Charge of Premises gr,tw_. sv14Nt
z
lP ase print)
IIJ Signature '//� Title 6M.11ba
DOH-1555(o7/18)p t of 2
Cr s.. 58
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#_ -_