Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Winslow, Chester Jay lV
1C:"..Y.) NEWYORKSTATEDEPARTMENTOFHEALTH �� ' Bureau of Vital Records Burial _ Transit Permit Name First Middle Last Sex Chester Jay Winslow IV Male Date of Death Age If Veteran of U.S.Armed Fortes, 02/12/2023 57 Years War or Dates " F.. Place of Death Hospital,Institution or Z City,Town or Village Milton Town Street Address 479 Rowland Street,Milton Town,New York 12020 UJ p Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation 0 Medical Certifier Name Title Aqeel Gillani MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed Town Of Milton District Number Register Number City,Town or Village 4561 07 Burial Date Cemetery,Crematory or Facility Name . 02/16/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation 0 Removal Date Place Removed and/or and/or Held F Hold Address N 0 O. Date Point of (/)Dransportation p by Common Shipment Carrier Destination oDisinterment 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 l• Remains are Shipped,If Other than Above 2 Address CC Ili 0. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/16/2023 Registrar of Vital Statistics Brenda 2fowe(E(ectronicat(y Signed) (signature) District Number 4561 Place Town Of Milton I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition 2 d--ZUZ3 Place of Disposition -Pi A)e j�. C/em,f 2 (address) W N CC (section) �� (lot number) (grave number/ SName of Sexton or Person in Cha e of Pre s s ►\ A�t nid b Li DI1 Z (please print W Signature iaft6 Title 0 I )---4.' r DOH-1555(o7/18)p 1 of 2 ". •.. ��,,: _.' .a k .L w�A 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#