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Demas, Kenneth NEW YORK STATE DEPARTMENT OF HEALTHq Vital Records Section Burial - Transit Permit Name First Middle Last Sex Kenneth R. Demas Male Date of Death Age If Veteran of U.S. Armed Forces, May 10,2017 72 War or Dates f,, Place of Death Hospital, Institution or Z: City, Town or Village Glens Falls Street Address Glens Falls Hospital °= Manner of Death X Natural Cause I I Accident Homicide Suicide Undetermined Pending W° Circumstances Investigation Medical Certifier Name Title :C'3 Manish Mehta Address 123 Quaker Rd.,Queensbury Death Certificate Filed District Numb r Register,Number _ City, Town or Village ,3iJd j d6 ❑Burial Date Cemetery or Crematory Entombment May 12,2017 Pine View Crematory 11 Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed Z Removal and/or Held and/or Address H Hold U) 0 Date Point of uTransportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address IPermit Issued to Registration Number :: Name of Funeral Home Alexander-Baker Funeral Home 00037 Address 3809 Main Street,Warrensburg,NY 12885 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above , Address le AU Permission is hereby granted to dispose of the human remains described above as i dicated. Date Issued 5/� f i 1 17 Registrar of Vital Statistics kiNDC-`A-4/"`Q. k, (signature) District Number 560 ( Place , .S P k\S, Y I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: wDate of Disposition c JiL Jn Place of Disposition Ping Li e,vio4td;,v— W (address) re 0 (section) // (lot number) (grave number) QName of Sexton or Person in Charge of Premises /Iir.3 kr ,Stin 1tt- Z (p ese print) W Signature —4 Title C ii (over) DOH-1555 (02/2004)