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Pidgeon Sr., Donald Louis i t • .. LF.. 51,c NEW YORK STATE DEPARTMENT OF HEALTH - Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Donald Louis Pidgeon Sr. Male Date of Death Age If Veteran of U.S.Armed Forces, 04/18/2023 87 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Day Town Street Address 36 Rice Road,Day Town, New York 12835 pManner of Death ❑X Natural Cause Accident ❑Homicide ESuicide InUndetermined Pending W Circumstances Investigation W Medical Certifier Name Title a George Siniapkin MD Address 604 Palmer Avenue,Corinth Town,New York 12822 Death Certificate Filed Town Of Day District Number Register Number City,Town or Village 4554 03 Burial Date Cemetery,Crematory or Facility Name 04/19/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held H N Hold Address 0 Date Point of f/)❑Transportation Shipment p by Common Carrier Destination Disinterment 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 i— Remains are Shipped,If Other than Above g Address IX W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/19/2023 Registrar of Vital Statistics Carol'Vaidancourt(ECectronical(y Signed) (signature) District Number 4554 Place Town Of Day I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 9-?2-445 Place of Disposition t'i/J . jJ Q� Cf-�om k. W N (section) (lotn ber/ (grave number) CC 8 Name of Sexton or Person in Charge Premis p ease print) W Signature K5 Aj Title DOH-1555(07/18)p 1 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#