Donnelly, John Albert PERMIT NUMBER
A COPY OF THIS PERMIT MUST STATE OF ARIZONA
ACCOMPANY THE BODY TO THE
FINAL DESTINATION. DEPARTMENT OF HEALTH SERVICES-BUREAU OF VITAL RECORDS
DISPOSITION TRANSIT PERMIT
DP2022-028045
1.DECEDENT'S LEGAL NAME(FIRST,MIDDLE,LAST.SUFFIX) __..Z.SEX 3.DATE OF BIRTH 4.DATE OF DEATH
IDENTIFICATION JOHN,ALBERT,DONNELLY MALE 02/28/1936 04/21/2022
OF DECEASED 5. PLACE OF DEATH-CITY OR TOWN 6.COUNTY 7.STATE
GILBERT MARICOPA ARIZONA
S.NAME AND ADDRESS OF FUNERAL FACILITY OR PERSON RESPONSIBLE
SCIENCE CARE,INC
2001 W PINNACLE PEAK ROAD#SUITE 175,PHOENIX,AZ 85027
9.NAME OF FUNERAL DIRECTOR OR RESPONSIBLE PERSON
MANNER AND PLACE KENNIE,K,DAVIS
10.METHOD OF DISPOSITION 11.NAME AND LOCATION OF I'''DISPOSITION FACILITY 12,DATE OF DISPOSITION
OF DISPOSITION
SCIENCE CARE,INC,
DONATION/CREMATION PHOENIX,AZ,US 04/29/2022
13.METHOD OF DISPOSITION 14.NAME AND LOCATION OF 2'DISPOSITION FACILITY 15.DATE OF DISPOSITION
SERENITY MORTUARY SERVICES,INC,
DONATION/CREMATION PHOENIX,AZ US 04/29/2022
.—____—__..�__ -16.MEDICAL EXAMINER'S AUTHORIZATION FOR CREMATION 17.DATE OF AUTHORIZATION
AUTHORIZATION COLLEEN.,KLEIN 04/26/2022
A.A.C.R9-19-313 REQUIRES THAT A PERSON IN CHARGE OF A PLACE OF FINAL DISPOSITION IN ARIZONA SHALL MAINTAIN A COPY OF THIS DISPOSITION TRANSIT PERMIT AT THE
PLACE OF FINAL DISPOSITION FOR AT LEAST FIVE YEARS AFTER THE ISSUE DATE
VS-8 Rev.7/2017
Certificate of Cremation
This is to certify that the remains of
John Albert Donnelly
Decedent Name
Serenity Mortuary Services
were cremated at(Facility Name)
May 2, 2022
on this day(Month,Day, Year)
by(51 at( e)
--
.Donnelly
Lot NO. 38
Address 10915 Sisson Road, So. Glens Falls, N.Y. 12801 Section No. , 2
Owner Agnes Donnelly
Plot SIT.
Date 11/6/82
Approx. 67 Superficial ft. @
Location Bounded by Vacant, South by Vacant, East by Road, West by Vacant
Corner Posts
Remarks
Deed No. (and changes) 1737
Payment Record Paid in Full 11/6/82
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Form No. 01
Record of Interments
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I John. F. Donnelly (11/6/82) { IA, 1-ljn ,'-flne-i 1 "7- :;d"
2 }" Agnes Pauline Donnelly 7/4/92
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DONNELLY
NAME John Albert Donnelly Age:
Lot Owner: Agnes Donnelly
Lot# S&i Sec @ #38 Grave# 1A
Case: Urn
Died: 4.21 .2 2 Interred: 7. 1 7.2 3
Funeral Home: Serenity Mortuary Services AZ.
Cemetery: Pine View