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Springer, Donald F Sr.
R i NEW YORK STATE DEPARTMENT OF HEALTH Burial -Transit Permit Bureau of Vital Records Name First Middle Last Sex Donald F Springer Sr Male Date of Death Age If Veteran of U.S.Armed Forces, 02/14/2023 82 Years War or Dates F— Place of Death Hospital,Institution or W City,Town or Village Glens Fails Street Address 43 Ridge Street 906,Glens Falls,New York 12801 0 Manner of Death Fl Natural Cause Accident Homicide Suicide Undetermined Pending V Circumstances Investigation W Medical Certifier Name Title C Shannon Evellis PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 87 Burial Date Cemetery,Crematory or Facility Name ® 02/16/2023 Pineview Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation 0111Removal Date Place Removed and/or and/or Held H Hold Address N O ----_1 IL Date Point of t/)UTransportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom h. Remains are Shipped,If Other than Above 2 Address IX W a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/16/2023 Registrar of Vital Statistics Megan Nolin(Electronically 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: ZW Date of Disposition 11,4 1/3 Place of Disposition le-i..V /.fir 2 (address) W CC /smybn/ (lot number (grave number) SName of Sexton or Person in Charge of iser '/A,,, rt //P mQ i i1ease print) W Signature `�1 Title 1197)(Z DOH-1555(07/18)p 1 of 2 -_ 411671.0 Public Health Law Sec. 4145(2b) Receipt Human remains of 51delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#-