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Lowell, David Joseph \ 85183820030 Schenectady City Clerk 02:40:06 p.m. 06-27-2022 1/2 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit ' Name First Middle Last David Joseph Lowell SexMale - Date of Death Age If Veteran of U.S.Armed Forces, `' 12/12/1975 6 years War or Dates Place of Death Hospital, Institution or City,IMPlittet Albany Street Address Albany Medical Center Manner of Death©Natural Cause 0 Accident EI Homicide ❑Suicide nUndetermined n Pending ____ Circumstances Investigation fil Medical Certifier Name Title .114 Address Death Certificate Filed District Number Register Number City,TjQpnlittlage Schenectady 4601 12347 ®Burial Date Cemetery or Crematory QEntombment 06/28/2022 Pine View Cemetery Address - `' Cremation Town Of Queensbury, N Y "" Date Place Removed ❑Removal and/or Held and/or Address — Hold 69 O. Date Point of Q Transportation Shipment to by Common Destination Carrier ©Disinterment Date Cemetery Address 06/28/2022 St.Joseph Cemetery;Schenectady,N Y `` Q Reinterment Date Cemetery Address Permit Issued to Registration Number s Name of Funeral Home Singleton Sullivan Potter Funeral Home D1596 <' Address 407 Bay Rd,Queensbury, N Y 12804 l!i!!ii Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address F. Permission is hereby granted to dispose of the human remains de= • . ' s. : ���� �,j� Indicated. Date Issued 06/27/2022 Registrar of Vital Statistics iu . , l n, (signature) 41 District Number 4601 Place Schenectady riii I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition G. ,e.aJ Place of Disposition (214 L k e R6 Cdu c�iti ('L7 AA/ ,' (address) J & e_.- 7L H (s ' (lot number) (grave number) Name of Sexton or Person in Charge of Prem' .< 444;4 (please print)I :* SignatureTitle 5v�<Q j n JeJ1 (over) DOH-1555(02/2004) LOWELL NAME David Joseph Lowell Age: 6 Lot Owner: Joan Lowell & Diane :Fowler Lot# Erie 76 3 Grave# 3 Case: Concrete Died: 1 2. 12 .75 Interred: 6.2 8.2 2 Funeral Home: Singleton Sullivan Potter Cemetery: Pine View