Singleton, Donald Joseph r 41 2s-I
•
NEWYORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle - Last Sex
Donald Joseph Singleton Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/17/2022 77 Years War or Dates 1965-1969
H Place of Death Hospital,Institution or
City,Town or Village Fort Edward Town Street Address 602 Lower Elizabeth Street,Fort Edward Town,New York 12828
EManner of Death a Natural Cause E2lAccident Homicide Suicide Undetermined ❑Pending
1/1Circumstances Investigation
W Medical Certifier Name Title
CI Robert Lemieux Coroner
Address
415 Lower Main Street.Hudson FaNs Village,New York 12839
Death Certificate Filed Town Of Fort Edward District Number Register Number
Cit ,Town or VillageE 5755 28
Burial Date Cemetery,Crematory or acuity Name
03/21/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
O❑Removal Date Place Removed
F and/or and/or Held
N Hold Address
g❑Transportation Date Point of
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
ElReinterment
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
F— 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 03/21/2022 Registrar of Vital Statistics Aimee GMa mmy(*EGctmxrarllySigxrd)
(signalure)
District Number 5755 Place Town Of Fort Edward
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
�1, I
Date of Disposition 1131 2L Place of Disposition -t '.,
11J (address/
W
N CC (section) (/ol number/ (gra re number)
ii
g Name of Sexton or Person in Charge of Premises CA ry ` 1 1r
z
- l /P ase print)
UJ Signature Title C+ Nr�
DOH 1555(07/18)p 1 of 2
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#