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Winne, Donald Warren NEW YORK STATE DEPARTMENT OF HEALTH �trmit Burial - Transit Pe Bureau of Vital Records Name First Middle Last Sex Donald Warren Winne Male Date of Death Age If Veteran of U.S.Armed Forces, 11/30/2023 89 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation la O Manner of Death El Natural Cause Accident 0 Homicide Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title O Courtney Diamond NP Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 560 Burial Date Cemetery,Crematory or Facility Name 12/04/2023 Pine View Crematory Entombment — Address ©Cremation Queensbury,New York Donation 0❑Removal Date Place Removed and/or and/or Held N Hold Address E ❑Transportation Date Point of a by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment 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 H Remains are Shipped,If Other than Above a' Address C W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/04/2023 Registrar of Vital Statistics Megan Wolin(Electronically 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: I— W Date of Disposition 121H I LL Place of Disposition �2 wEci s..) Cf" t ro i21/ 2 (address) W N Cr (section)(section) (lot number) (grave number) SName of Sexton or Person in Charge of Premises 4 ,s 1.-- Zv-a it Z ( � ease print) W Signature g Title f m41/2 DOH-1555(07/18)p t of 2 Tid ,s 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#