Bayer, Harry vyi
li
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Harry V. Bayer Male
Date of Death Age I If Veteran of U.S. Armed Forces,
09 / 01 / 2017 86 War or Dates
•i Place of Death Hospital, Institution or
3 City, Town or Village Wilton Street Address 201 Wilton Commons Dr.
u Manner of Death® Natural Cause C Accident El Homicide _Suicide Undetermined —Pending
Circumstances —Investigation
;u Medical Certifier Name Title
Q John E. Lukaszewicz MD
Address
84 Broad St. , Glens Falls, NY 12801
Death Certificate Filed District Number 4/-5'69 Register,J,V ber
City, Town or Village Wilton �//
0Burial Date Cemetery or Crematory
09 / 05 / 2017
n Entombment Pine View Crematory
Address
Cremation Queensbury, NY
Date Place Removed
Z❑Removal and/or Held
,, and/or Address
7 Hold
fl Date Point of
Q Transportation Shipment
Cs by Common Destination
Carrier
Disinterment Date Cemetery Address
'` Q Reinterment Date i Cemetery Address
Si Permit Issued to1 Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave. , Saratoga Sp. , NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
E Address
Ii
Permission is hereby granted to dispose of the human remai s described above as indicated:
Date Issued Ci . //Registrar of Vital Statistics ,� t(.�CCL.��cc ,,.,1Gi0 /�,
District Number " j (signature)
G 6 lsl l Place Wiltonf.O , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
3 Date of Disposition i poi n Place of Disposition inctL.J otin•C f'dr1r✓
2 (address)
ILI
at (section) a(lot number) (grave number)
el Name of Sexton or Person in Charge of Premises f A�=, Q�ia` t via
2 (please print)
111
//
Signature �''" • +'rt7" Title 1e-1N12e`'..
(over)
DOH-1555 (02/2004)