Reese, John Lee II 6
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit fermi
Name First Middle Last Sex
John Lee Reese Male
Date of Death Age If Veteran of U.S.Armed Forces,
08/30/2022 89 Years War or Dates Air Force
H Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
UJ
Manner of Death 0 Natural Cause IllAccident ❑Homicide Suicide Undetermined Pending
V Circumstances Investigation
W Medical Certifier Name Title
CI Asim Chaudry MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 448
Burial Date Cemetery,Crematory or Facility Name
09/01/2022 Pine View Crematory \�
Entombment Address
Cremation Queensbury Town,New York
EiDonation
OZ❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
O. Date Point of
Cl)ETransportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Ill 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
I— Remains are Shipped,If Other than Above
2 Address
1r
W
CL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/01/2022 Registrar of Vital Statistics Megan No(in(EfectronicaltySigned)
(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:
I—
Z Date of Disposition K 121 27_ Place of Disposition 4'1 dL / �
W
2 (address)
W
N CC (section) / (jot number) fwvirt /gra ve number)
`A r. L S
aName of Sexton or Person in Charge oemises
Z / ease print)
W Signature Title (mirk
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#