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Burrows, Donald Town of Queensbury IOWA Certification of Cremation r, Pine View Cemetery and Crematory This certifies that the remains of: Donald Burrows were cremated on September , is 20 23 at the Pine View (Month) (Day) Crematorium, Queensbury,New York, and these are the cremated remains of said body. Date of Death September , s 20 23 Age 85 (Month) (Day) Funeral Home Baker Funeral Home Registered No. 749 (Authorized Signature) BURROWS - Owner Darnel Burrows Address Plot 74 McDonald St. Glens Falls. NY 12801 nnpiaa Phone # Lot # 518-681 -6747 7 Deed # Date 4405 9.11 .23 Cost Foundation Y - N $1600.00 Location Road North- South-Karl East-Grassy area West- Lindsey Remarks I ACKNOWLEDGE THE RECEIPT OF THE RULES AND REGULATIONS OF THE PINE VIEW C ETERY: SIGNATURE i (1 V DATE 6( ( ' `-),9 SIGNATURE: DATE: Record of Interments 1 -� b 9,y- aoa. 6 3 1._: t1C�i1 t t-rc S S av a -6 2 7 3 8 4 9 5 10 ys n x r 5 S S 1 Burrows r'- NAME Donald Burrows Age: 85 CLE Lot Owner: Darnel Burrows Lot# Oneida 7 Grave# 1 Case: Urn Died: 9.9 .2 0 2 3 Interred: 9 .2 0.2 3 Funeral Home: Baker FH Cemetery: Pine View —)ut NEW YORK STATE DEPARTMENT OF HEALTH e Burial - Transit Permit Bureau of Vital Records �r Name First Middle Last Sex Donald Nelson Burrows Male Date of Death Age If Veteran of U.S.Armed Forces, 09/09/2023 85 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address 74 McDonald Street,Glens Falls, New York 12801 p Manner of Death ❑X Natural Cause Accident ❑Homicide OSuicide ElUndetermined Pending W Circumstances Investigation W Medical Certifier Name Title 0 Gerard Abess MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 432 RBurial Date Cemetery,Crematory or Facility Name 09/18/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York EiDonation ❑Removal Date Place Removed and/or and/or Held F Hold Address 0 0. Date Point of toTransportation Q by Common Shipment 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 Remains are Shipped,If Other than Above 2 Address IIr W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/13/2023 Registrar of Vital Statistics Megan Nofin(ECectronicaCCy 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: ' ~ v� W Date of Disposition 9 11917.3 Place of Disposition k 'LIL. (address) W N°` got (section/ number/ (grave number) g Name of Sexton or Person in Charge o 'ses — 'f Et- (pleas tint) W Signature Title l '7n)4R DOH-1555(07/18)pi of 2 s k n ` 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# } ,