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Parker, Don Rice NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Per it Bureau of Vital Records Name First Middle Last Sex Don Rice Parker Male Date of Death Age If Veteran of U.S.Armed Forces, 01/28/2024 90 Years War or Dates h Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation WW Manner of Death Undetermined Pending Natural Cause Accident Homicide Suicide U Circumstances Investigation W Medical Certifier Name Title 0 Jennifer Donovan DO 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 56 EdBurial Date Cemetery,Crematory or Facility Name 01/29/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York ▪Donation 0❑Removal Date Place Removed and/or and/or Held I Hold Address N 0 O. Date Point of N Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address EIReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500,Lake Luzerne,New York 12846 Name of Funeral Firm Making Disposition or to Whom F. Remains are Shipped,If Other than Above "t Address CC W EL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/29/2024 Registrar of Vital Statistics Megan Nolin(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: Il— Z Date of Disposition 113a Ill Place of Disposition FTot,Ev,ytr,,.1 Ca v 4. 'G1+� ILI 2 (address) W N CC (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises A.,1,,,, 3-x ,t, z please print) W Signature ��� ...„ Title 1 � DOH-1555(07/18)p 1 of 2 p. �a) w.i 0 ' 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#