Corr, Mark A `g //
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
w Mark
P. Corr Male
Date of Death Age If Veteran of U.S. Armed Forces,
`..$` April 15,2017 52 War or Dates
Place of Death�� Hospital, Institution or
:e City, Town or Village Warrensburg Street Address 35 Horicon Avenue
Itt
x Manner of Death Natural Cause Accident I I Homicide Suicide Undetermined x Pending
Circumstances Investigation
Medical Certifier Name Title
William Orluk Coroner
`- Address
r: Chester Health Center,Chestertown,NY 12817
Death Certificate Filed District Number Register Number
City, Town or Village Warrensburg 5660
❑Burial Date Cemetery or Crematory
❑Entombment April 20, 2017 Pine View Crematory
Address
0 Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z I I Removal and/or Held
9 and/or Address
- Hold
_ _
a Date Point of
rn I I Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
e `y Address
a 3809 Main Street,Warrensburg,NY 12885
='i:a Name of Funeral Firm Making Disposition or to Whom
b Remains are Shipped, If Other than Above
A: Address
I
Permission is hereby granted to dispose of the human remains de ibed above as indicated.
Date Issued b��7 Registrar of Vital Statis cs — _,- �k 4,_.'
{72
(signature)
:= District Number 61,6,0 Place T/O Warrensburg,NY
I certify that the remains of the decedent identified above were disposed of in accordance
with this permit on:
Z p l 4/(7 DispositionFllle_V r +lt
� Date of Disposition / Place of � ����,,
2 / (address) t
CD
Ce
(section) cf�� (lot n mber) (grave number)
Z Name of Sexton or on i Charge of Premises .Jr,,, (;:at,., G4"Ka-c�-�
Z (please print)
Signature Title Gi'�,-✓ ia,"
(over)
DOH-1555 (02/2004)