Knapp, Kevin Mitchell NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Kevin Mitchell Knapp Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/13/2023 64 Years War or Dates
l` Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 33 Smoke Ridge Road,Queensbury Town,New York 12804
W Manner of Death X g
� �NaturalCause Accident Homicide Suicide Undetermined �Pendin
W Circumstances Investigation
W Medical Certifier Name Title
0 Michael Bell ME
Address
11650 NW 21st CT,Plantation,Florida 33323
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 7
Burial Date Cemetery,Crematory or Facility Name
01/17/2023 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held _
H Hold Address
N
0
d Date Point of
U)ElTransportation Shipment
p by Common
Carrier Destination
Disinterment Date Cemetery Address
ilReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
S Address
CC
W
0-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/17/2023 Registrar of Vital Statistics Caroline. CiCcfegardeBar6er(ECectronicalfySigned)
(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 permit on:
WDate of Disposition I I I'I(73 Place of Disposition -F.1�- -----
2 (address)
W
CCCC (section) (lot number) (grave number)
a Name of Sexton or Person in Charge of Premises 7j4k\c -,
Z ./0 /jlease print)
W Signature Title tila
DOH-1555(07/18)p 1 of 2
r. C16602
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#