Englert, John Frank - —": # 56g
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
John Frank Englert Male
Date of Death Age If Veteran of U.S.Armed Forces,
05/06/2022 84 Years War or Dates Army
P Place of Death
Hospital,Institution or
Z- City,Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death Natural Cause Accident El Homicide Suicide nUndetermined ❑Pending
W Circumstances Investigation
W Medical Certifier Name Title
0 Jeremy Di Bari MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 255
Burial Date Cemetery,Crematory or Facility Name
05/09/2022 Pine View Crematory
Entombment Address
['Cremation Queensbury,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
Date Point of
t/!'❑Transportation Shipment
Q by Common
Carrier Destination
O
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
t Remains are Shipped,If Other than Above
2 Address
Q
W
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/09/2022 Registrar of Vital Statistics £Megan Wolin(Efectronica1TySigned)
(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: /��
~ � l/tr.— �
Z Date of Disposition ��/i�2Z Place of Disposition 'l ��
UJ
2 (address)
W
NCC (section) /11
(lot number) (grave number)
iiC Name of Sexton or Person in Char a of Premise i �
W /�� (plea���"`print)/� ,
Signature LJ I Title ` �1¢7fj�
g
DOH-1555(o7/B8)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#