Winchell, Shane Michael (SI
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Shane Michael Winchell Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/15/2023 30 Years War or Dates
F Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death Natural Cause []Accident ❑X Homicide Suicide Undetermined ElPending
W Circumstances Investigation
C)
W Medical Certifier Name Title
C3 Timothy Murphy Coroner
Address
52 Haviland Avenue,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 592
I Burial Date Cemetery,Crematory or Facility Name
12/20/2023 Pine View Cemetery
Entombment
_ Address
IIICremation Queensbury Town,New York
Donation
goRemoval Date Place Removed
and/or and/or Held
H Hold Address
N
0
O. Date Point of
U)['Transportation
p by Common Shipment
Carrier Destination
111
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped,If Other than Above
a Address
5
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/19/2023 Registrar of Vital Statistics Megan Nofn(E(ectronica((ySigned)
(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-
WDate of Disposition \Q. •D-3 Place of Disposition 0 k .ejdz k Rv- E'�� / 1, Ia 4.4
2 (address)
Ch
Q / tnumber L (grave number)
SName of Sexton or Person in Charge of Premis • 6. 4r11-1oC �� 1
(Pleat)��,4
Ili Signature /� .t Title L I"- t/1
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) U `u
Receipt
Human remains of delivered on , 20
P&he View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#
WINCHELL Lot No. 18-E
Address 4 1/2 COTTAGE PLACE, GLENS FALLS NY 12801 LF Section No.
Owner BR I AN W I NCHELL Plot SENECA
Date 12/29/05
APPROX. 67 Superficial ft.
Location ROUNDED ON NORTH BY HENDRY, SOUTH BY VACANT, EAST BY DUNLEAVY, WEST BY WINCHELL.
Corner Posts
Remarks
Deed No. (and changes) 3399
Payment Record PAID IN FULL 12/29/05 ($1,000.00)
Record of Interments - i ' Va. 5)37
to;n c�ne1l 1 I a Y
2 75.
9
, ^ 7. _
V 4 C .t/
Form No. 01
WINCHELL
NAME Shane Winchell `age` 30
Lot Owner: Brian Winchell
Lot# Seneca 18 E Grave# 1
Case: Concrete
Died: 1 2. 1 5.2 3 Interred: 1 2.2 0 .2 3
Funeral Home: Carleton FH
Cemetery: Pine View