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Welch, Daniel Joseph Sr. / # g-z i11 NEW YORK STATE DEPARTMENT OF HEALTH .._J Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Daniel Joseph Welch Sr Male Date of Death Age If Veteran of U.S.Armed Forces, 10/12/2023 92 Years War or Dates Army l— Place of Death Hospital,Institution or Z City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare G▪ Manner of Death a Natural Cause lilAccident El Homicide Suicide riUndetermined ❑Pending W Circumstances Investigation U W Medical Certifier Name Title O Deborah Norris NP Address 4573 State Route 40,Argyle Town,New York 12809 Death Certificate Filed Town Of Argyle District Number Register Number City,Town or Village 5750 J 47 Burial Date Cemetery,Crematory or Facility Name 10/16/2023 Pine View Crematory Entombment Address ©Cremation Queensbury,New York Donation ZO❑Removal Date Place Removed and/or and/or Held (— Hold Address N 0 n. Date Point of N❑Transportation p by Common Shipment Carrier Destination Disinterment 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 1— Remains are Shipped,If Other than Above 1" Address C W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/16/2023 Registrar of Vital Statistics SlreakeyAWckernon(fIaronica/T Signed) (signature) District Number 5750 Place Town Of Argyle I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— WDate of Disposition PI 11(l3 Place of Disposition -�TNE✓i't,,, 6ac�^"t�l 1-01X 0---_ 2 (address) W Cl)CC (section) r7 (lot number) (grave number/ G bf- Name of Sexton or Person in Charge of Prem. °" l— ^e Z (pie a print) W Signature Title �eQ DOH-1555(07/18)p 1 of 2 ff17 7 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#