Messerie, Paul 1 log.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Paul Edgar Messerle Male
flit Date of Death Age _ U.S. Armed Forces,
ii
OM 11/04/2018 75 Years War or Da . 62-65
Place of Death Hospital, Institution or
e1r7`-` City, Town or Village Glens Falls Street Address Glens Falls Hospital
'-' Manner of Death X❑Natural Cause ❑Accident "'N Homicide E Suicide ❑Undetermined ❑Pending
7 Circumstances Investigation
Medical Certifier Name Title
Nawed Siddiqui MD
,, Address
▪ 100 Park St,Glens Falls,New York 12801
° Death Certificate Filed District Number Register Number
E Cit , Town or Villase Glens Falls 5601 520
❑Burial Date Cemetery or Crematory
11/06/2018 Pine View Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or
Address
Hold
Date Point of
❑Transportation Shipment
- by Common Destination
Carrier
op▪ ❑Disinterment
Date Cemetery Address
g❑Reinterment Date Cemetery Address
', Permit Issued to Registration Number
▪ Name of Funeral Home Alexander Baker Funeral Home 00037
Address
c. 3809 Main St,Warrensburg,New York 12885
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 11/06/2018 Registrar of Vital Statistics cgbertA Curtis(ECectronicalTy Signed)
(signature)
District Number 5601 Place Glens Falls, New York
Et I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
l
Date of Disposition II 11 M' Place of Disposition PMU� (Fib—
... (address)
(section) f lot number) (grave number)
70-1
Name of Sexton or Person in Charge of Premises /ir4� b Su,*
(plea be print)
Signature _ �1 Title (i -0h�t�Y1
(over)
DOH-1555 (02/2004)
I
NEW YORK STATE DEPARTMENT OF ii /T 2 5-2
Vital Records 3eCtlan 1111101 ' limit ftr11111
NEW YORK STATE DEPARTMENT OF rc i v
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