Donovan, Kevin T 14 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Kevin T Donovan Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/23/2023 72 Years War or Dates
1_ Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
UJ
0 Natural Cause Accident Homicide Suicide
Manner of Death Undetermined Pending
111
0Circumstances Investigation
W Medical Certifier Name Title
0 Marvin Davidowitz MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 606
.0 Burial Date Cemetery,Crematory or Facility Name
12/27/2023 Pine View Cemetery
Entombment
_ Address
Cremation Queensbury Town,New York
Donation
ZO Removal Date Place Removed
and/or and/or Held
~ Hold Address
CO
O
O. Date Point of
(p Transportation
a by Common Shipment
Carrier Destination
o
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
1— Remains are Shipped,If Other than Above
2 Address
LC
W
EL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/26/2023 Registrar of Vital Statistics Megan No(in(ECectronica1Ty 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:
Date of Disposition Q r-)1 3 Place of Disposition 1 Ci\6, jZ Ir.. ` 1 A ZS F-.ac` J 6 5/
LU
(address)
N (3r,� a
It (section) � (tomumber) � (grave number)
a Name of Sexton or Person in Charge of Pr ' s C�'1�'7r e av/Cci p
(p/e/ass-e__print)// __
W Signature /� Title . ti 1/1�/t cam/`
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
•
7' .,
�.�
Pyfle View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
o1,
+BIS HOP tr... Lot No. 23B & 214.0
Address 39 Arbor Drive, Glens Falls , N.Y. Section No. 3rd
Dwner John W. Bishop Plot New Hudson
Date 9/3/66
(2,0�)100 1.S 0per s . ft. _ )450.00
Approx. (2 100 Superficial ft. @ q
Location Bounded on the n/w by Waggaman; on the n/e by path
Corner Posts •
Remarks
Deed No. (and changes) #992
Payment Record Paid in'full 9/3/66
DONOVAN
NAME Kevin Donovan 72
Lot Owner: John W. Bishop
Lot# New Hudson Grave# 2
SEC. 3 Lot23B
Case: Concrete
Died: 1 2 .2 3 .2 3 Interred1 2.2 7.2 3
Funeral Home: Regan Denny Stafford
Cemetery: Pine View