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Chadwick, Donald W
e 'd� NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Donald W Chadwick Male Date of Death Age If Veteran of U.S.Armed Forces, 01/28/2024 73 Years War or Dates Army Place of Death Hospital,Institution or WCity,Town or Village Granville Village Street Address Granville Center for Rehabilitation and Nursing Manner of Death Natural Cause Accident Ei Homicide nSuicide nUndetermined r7 Pending W U Circumstances Investigation WW Medical Certifier Name Title Joshua Started NP Address 17 Madison St,Granville Village,New York 12832 Death Certificate Filed Village Of Granville District Number Register Number City,Town or Village 5725 3 , Burial Date Cemetery,Crematory or Facility Name 01/30/2024 Pine View Crematory _Entombment Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held N Hold Address O fl Date Point of (I) Transportation ES Common Shipment Carrier Destination EIDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury, New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 5 Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/30/2024 Registrar of Vital Statistics Diana ScarCotta(ECectronica1Ty Signed) (signature) District Number 5725 Place Village Of Granville I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition 1131 174 Place of Disposition Flirty*,,J Cl� TOETIAA., 2 (address) W CC (section/ (lot number) (grave number) GIH Name of Sexton or Person in Charge of Premises/ _ Cis 1-- --1w+n' release print/ W Signature L ' Title llMTV�� DOH-1555(07/18)p i of 2 Public Health Law Sec. 4145(2b) Receipt 1 Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#