Duell, Charles F 271
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Charles F.Duell Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/06/2023 61 Years War or Dates Nat.Guard 1981-1986
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death El Natural Cause Accident ❑Homicide Suicide Undetermined Pending
W
U Circumstances Investigation
GMedical Certifier Name Title
Kasandra Frasier 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 130
Burial Date Cemetery,Crematory or Facility Name
03/09/2023 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
OZ❑Removal Date Place Removed
and/or and/or Held
N Hold Address
0
O. Date Point of
Cl)❑Transportation
Q by Common Shipment
Carrier Destination
ODisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped,If Other than Above
Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/09/2023 Registrar of Vital Statistics Megan.Norn(IE/ctronicalry 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:
Z Date of Disposition 3l10 I z3 Place of Disposition V
W
2 (address)
W
N
CC (section) /,�(lot number) S (grave number)
gName of Sexton or Person in Charge of Premises, ///�/• 1� /f
Z /p se print/
IL Signature Title `
DOH-1555(07/18)p t of 2
01 778
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#