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Cook, Eric , . _ , NEW YORK STATE DEPARTMENT OF HEALTH 3 () Vital Records Section Burial - Transit Permit Name First Middle Last Sex Eric R. Cook Male Date of Death Age If Veteran of U.S. Armed Forces, trw a April 29, 2017 69 War or Dates ZPlace of Death Hospital, Institution or ` City, Town or Village Warrensburg Street Address 12 Third Avenue tzt Manner of Death I XI Natural Cause Accident n Homicide Suicide Undetermined Pending t Circumstances Investigation wr Medical Certifier Name Title ittla William A. Tedesco Dr. :;< - Address �' Three Iron Gate Center,Glens Falls,NY 12801 N6 Death Certificate Filed District Number Register Number „; City, Town or Village T/O Warrensburg, NY 5660 ❑Burial Date Cemetery or Crematory ❑Entombment May 2, 2017 Pine View Crematory Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed OZ n Removal and/or Held and/or Address E Hold Cl) 0 Date Point of y Transportation Shipment p by Common Destination Carrier n Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander-Baker Funeral Home 00037 : ; Address ;51dan 3809 Main Street, Warrensburg,NY 12885 °, ° Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address .1 . n°, Permission is hereby granted to dispose of the human re 'ns described a ove as Indic ted. G . Date Issued 5/02 !I Registrar of Vital Statistics � ��"�--� ai,-,� � /� _ (signature) / District Number 5b( () Place T/O Warrensburg,N I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition 3/310 Place of Disposition 'GAIN/ (0.00or i,,..� W (address) U) Ce 0 (section) / (lot umber) (grave number) p Name of Sexton or Person in Charge of remises /hrs-�p q ��+�}��" Z (pl ase print) Ili Signature N Title 121;► ''- (over) DOH-1555 (02/2004)