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Bauer, Raymond v it1iZ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit : Name First Middle Last Sex 14 Raymond G.Bauer Male 4,4 Date of Death Age If Veteran of U.S. Armed Forces, 09/13/2017 80 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause El Accident El Homicide ❑Suicide El❑Undetermined ❑Pending 0 Circumstances Investigation , 1 Medical Certifier Name Title Frances Bollinger MD Address 100 Park St,Glens Falls,New York 12801 ,44 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 485 ❑Burial Date Cemetery or Crematory 09/14/2017 Pine View Crematory El Entombment Address ®Cremation Queensbury Town, New York v Date Place Removed ❑Removal and/or Held and/or Address Hold Date Point of ❑Transportation Shipment i .' by Common Destination Carrier Disinterment Date Cemetery Address cx,_❑Reinterment Date Cemetery Address Permit Issued to Registration Number 0. Name of Funeral Home Maynard D Baker Funeral Home 01130 rr Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/14/2017 Registrar of Vital Statistics Rp6en.Acurtis ETaronicaaysigned'4; (signature) District Number 5601 Place Glens Falls, New York 11 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 4119 0 Place of Disposition x(, ., 4 f. . (address) 7 (section) of number) (grave number) Name of Sexton or Person in Charge of Pre ises _ krM4Y'f 11- /� (pl a punt) Signature !r'� '� Title (( 1a19 (over) DOH-1555 (02/2004)