Bovair, Roland E 25g
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Roland E Bovair Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/19/2022 48 Years War or Dates
F.. Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death ❑X Natural Cause OAccide 'de Duicide Undetermined ri Pending
W Circumstances Investigation
WMedical Certifier Name Title
0 Abigail Macomber PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 1 171
Burial Date Cemetery,Crematory or Facility Name
03/21/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
H Hold Address
0
Date Point of
(I) Transportation Shipment
Q by Common
Carrier Destination
Date Cemetery Address
Disinterment
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
2 Address
Q
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/21/2022 Registrar of Vital Statistics Megan Wolin(ECectronicalrySigned)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
�
Z Date of Disposition )lz 1Z2 Place of Disposition 1 0 u,
W (address)
W
N CC (section) (lot number) (grave number)
-_-,
S Name of Sexton or Person in Charge of Pr ises �Q ""^',if
(•phase print)
h
W Signature Titlerit
DOH-1555(07/18)p 1 of 2
Ti 1 t'qf
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
/;9 J,
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#