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Collins, Kyle David C. r•-:"*. 730 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kyle David Collins Male Date of Death Age If Veteran of U.S.Armed Forces, 03/01/2024 53 Years War or Dates F, Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 21 Lehland Drive, Queensbury Town, New York 12804 p Manner of Death Natural Cause Accident Homicide Suicide ❑Undetermined Pending Circumstances Investigation WMedical Certifier Name Title G Timothy Murphy Coroner Address 52 Haviland Avenue,Glens Falls,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 36 Burial Date Cemetery,Crematory or Facility Name 03/04/2024 Pine View Crematory Entombment Address ©Cremation Queensbury,New York Donation 0❑Removal Date Place Removed and/or and/or Held F- Hold Address N 0 d Date Point of Cl) Transportation Q by Common Shipment Carrier Destination ODisinterment Date Cemetery Address rj Reinterment 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 CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/04/2024 Registrar of Vital Statistics Caroline_Vinegar*Barber(ECectronica((ySigned) (signature) District Number 5657 Place Town Of Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition 31(,114 Place of Disposition Tn-,....,.....1 C,,Ac' reez✓"-- 2 (address) W CC (section) (lot number) (grave number) 8 Name of Sexton or Person in Charge of mises 4,tt_ S f ' se print) W Signature Title / tnp�Q DOH-1555(07/18)p 1 of 2 ti (: ;r 0-1 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#