Stockman, Donald t,
Town of Queensbury
_ Certification of Cremation
s � Pine View Cemetery and Crematory
This certifies that the remains of: Donald Stockman
were cremated on November , 18 20 22 at the Pine View
(Month) (Day)
Crematorium, Queensbury,New York, and these are the cremated remains of said body.
Date of Death November _ , 15 20 22 Age 86
(Month) (Day)
Funeral Home Baker Funeral Home Registered No. 900
(Authorized Signature)
STOCKMAN
NAME Donald Stockman Age: 86 t
Lot Owner: William & Richard Threw & Donald
Stockman
Lot# Hudson #3 Lot 34 Grave# 7
Case: Urn
Died: 1 1 .1 5.2 2 Interred: 1 1 .29.22
Funeral Home: Baker FH
Cemetery: Pine View
i -
\ It ,CC
NEW YORK STATE DEPARTMENT OF HEALTH Lir Burial - Transit Permit
Bureau of Vital Records c-
Name First Middle w,, Last Sex
Donald Preston Stockman Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/15/2022 • 86 Years War or Dates
F— Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death
W Natural Cause Accident ITI Homicide Suicide Undetermined ❑Pending
V I—ICircumstances Investigation
LLI C Medical Certifier Name Title
Aaron Heckler PA
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 577
Burial Date Cemetery,Crematory or Facility Name
-11/16/2022 Pine View Crematory
Entombment -Adilress
Cremation Queensbury Town,New York
ElDonation
6❑Removal Date Place Removed
and/or and/or Held
F Hold Address
N
0
O. Date Point of
U)['Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
fv Remains are Shipped,If Other than Above
2 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/16/2022 Registrar of Vital Statistics Megan (Electronica(Signed)
(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 ll1 I$(1Z Place of Disposition PMV—
W
2 (address)
W
CO (section) (lot number) ('�, (grave number)
SName of Sexton or Person in Charge of Pre 's On t‘v 4-- .RA... n
z (p/eae print)
W Signature Title ���/nla�✓�
DOH-1555 l07/18)p 1 of 2
♦ ,^r 1 6�,! 11
Public Health Law Sec. 4145(2b) 1
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
A 0/
- .
Form No. 01 01 191
Record of Interments V
7/
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Rosemary W . Threw A/ 11/9R
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THREW —ST7X14/144-i l
William Threw, Richard Threw,&Donald Stockman Lot No. 34
kddress Luzerne Road, RD/3, Glens Falls, N.Y. Section No. 3
)wner William Threw, Richard Threw & Donald Stockman PlotNew Hudson
Vounc$'
)ate May 9, 1968
400 Superficial ft. @ $1.50 per Sq.Ft.
,ocation bounded North, East, South and West by grass paths. South by lots of
King and Frasier
:orner Posts
remarks
r�L n,cl c,`<-r'c r-T r4 TX c-„:, fAi: tea A:Tt.L 1 N ye 5//
C792 - 3062) a P w
)eed No. (and changes) 11047
'ayment Record May 9, 1968 Paid in Pull
STOCKMAN
NAME Donald Stockman Age: 86
Lot Owner: William & Richard Threw & Donald
Stockman
Lot# Hudson #3 Lot 34 Grave# 7
Case: Urn
Died: 1 1 .1 5.2 2 Interred: 1 1 .2 9.2 2
Funeral Home: Baker FH
Cemetery: Pine View