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Piper, Donald Chester Sr.
4 gcr NEW YORK STATE DEPARTMENT OF HEALTH t � Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Donald Chester Piper Sr. Male Date of Death Age If Veteran of U.S.Armed Forces, 10/21/2023 93 Years War or Dates 1951-1953 i.. Place of Death Hospital,Institution or Z City,Town or Village Granville Town Street Address Slate Valley Center for Rehabilitation and Nursing W Manner of DeathUndetermined Pending W Natural Cause Accident HomicideSuicide g Circumstances Investigation W Medical Certifier Name Title a Joshua Started NP Address 10421 State Route 40,Granville Town,New York 12832 Death Certificate Filed Town Of Granville District Number Register Number City,Town or Village 5756 59 EIBurial Date Cemetery,Crematory or Facility Name 10/24/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held ~ N Hold Address 0 O. Date Point of ()OTransportation p 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 F.. Remains are Shipped,If Other than Above a Address III O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/24/2023 Registrar of Vital Statistics Jenny Linda M MarteCCe(ECectronicaCCy Signed) (signature) District Number 5756 Place Town Of Granville I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IH Z Date of Disposition ID i ZS I I3 Place of Disposition 'T 1 d 6..J (Pt,M £T d, UJ 2 (address) W N (section) (lot number) (grave number) 8 Name of Sexton or Person in Charge of Premises Z (lease print) W Signature Title AM4 DOH-1555(07/18)pi of 2 t .. r 317603 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 i , Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# 1