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Edwards, John George I #Z�I NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John George Edwards Male Date of Death Age If Veteran of U.S.Armed Forces, 03/11/2023 88 Years War or Dates Army ZPlace of Death Hospital,Institution or City,Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death 1=1 Natural Cause Accident El Homicide ESuicide Undetermined ❑Pending ILI 0 Circumstances Investigation E Medical Certifier Name Title Mathew Varughese DO 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 137 'el' ^Burial Date Cemetery,Crematory or Facility Name 03/14/2023 Pine View Crematory Entombment — Address ©Cremation Queensbury,New York Donation 2❑Removal Date Place Removed and/or and/or Held Hold Address KDate Point of Transportation Shipment by Common Carrier Destination j Disinterment Date Cemetery Address 410 Date Cemetery Address El Reinterment 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 Remains are Shipped,If Other than Above X Address E O.. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/14/2023 Registrar of Vital Statistics Megan Wo(in(ECectronicalTySigned) (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: Date of Disposition 3j Place of Disposition "l� t,L Zh- al 2 (address) W • I (section) / (lotnumberl-- (grave number) 8 Name of Sexton or Person in Charg- 'remisesAl.— Ilt ease print) Signature � Title r('4YY1y}�'GJ� DOH-1555(07/18)pi of 2 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#