Povie, Donald S. Jr. 41 c3'v
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Donald S.Povie Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/15/2022 92 Years War or Dates
l_ Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing
EMannerof Death ID Natural Cause DAccident 0 Homicide ❑Suicide Undetermined ElPending
C) Circumstances Investigation
W Medical Certifier Name Title
a
Roslyn Socolof MD
Address
42 Gurney Ln,Queensbury Town,New York 12804
Death Certificate Filed Town Of Queensbury District Number Register Number
Cit E,Town or Village 5657 154
Burial Date Cemetery,Crematory or Facility Name
10/18/2022 Pine View Crematory
Entombment Address
EICremation Query Town,New York
Donation
❑Removal Date Place Removed
and/or and/or Held
N Hold Address
0
n. Date Point of
U) Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
EIReinterment
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
I— Remains are Shipped,If Other than Above
S Address
CC
W
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/18/2022 Reg strar of Vital Statistics Carodne9fi egankauSer(EGetrtmea(JJpvd)
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permiton:
W Date of Disposition /o I l91Z2 Place of Disposition ,r V /'per_
A.A. V
a (adikessl
W
CC (section) (lot numb (grave number)
Name of Sexton or Person in Charge of remises A. ivN,It
z
,/p
z /please print/
/i
W Signature L/ Title /leF/i1µi joYt
DOH 1555(o7/18)p 1 of 2
- - - `... ... U�..' ...
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#
Town of Queensbury
Certification of Cremation
Pine View Cemetery and Crematory
This certifies that the remains of: Donald S Povie Jr.
were cremated on October 19 20 22 at the Pine View
(Month) (Day)
Crematorium, Queensbury,New York, and these are the cremated remains of said body.
Date of Death October 15 20 22 Age 92
(Month) (Day)
Funeral Home Regan Denny Staffor Registered No. 830
(Authorized Signature)
POVIE
Owner
04!)
Chris Povie
Address Plot
169 Farr Lane, Queensbury, NY 12804 Niche Wall Back
Phone # Lot #
518-669-7540 A-1 West
Deed # Date
19 10.2723
Cost Foundation Y - N
$1725. 00
Location
West-grass
east-vacant
South-road (Quaker Rd)
north-vacant
Remarks
Record of Interments
l d
. 15 •
1 as 6
16: tee. vat,. aoAltto 7
II a3
3 8
4 9
5 10
4 (•. ax e S
C
a A
Povie
NAME Donald S. Povie Jr. Age: 92
Lot Owner: Chris Povie
Lot# Niche Wall Back West Al Grave# Al
Case: Urn
Died: 1 0 .1 5.2 2 Interred: 11 . 1 7 .23
Funeral Home: Family Chris Povie
Cemetery: Pine View