Burdett, Donald R. -741
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Per it
Bureau of Vital Records
Name First Middle Last Sex
Donald R.Burdett Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/31/2019 81 Years War or Dates 1957-1960
Place of Death Hospital,Institution or
Z City,Town or Village Johnsburg Town Street Address Elderwood at North Creek
`p Manner of Death ❑X Natural Cause Accident Homicide Suicide ❑Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
G Kate Sauer-Jones PA
Address
112 Ski Bowl Rd,Johnsburg Town,New York 12853
Death Certificate Filed District Number Register Number
City,Town or Village North Creek 5655 45
Burial Date Cemetery,Crematory or Facility Name
11/07/2019 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
ZO Removal Date _7Place Removed
and/or and/or Held
F- Hold Address
f�
O
d Date Point of
N Transportation Shipment
Q by Common
Carrier Destination
Disinterment
Date Cemetery Address
1EIReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
R
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/04/2019 Registrar of Vital Statistics Kathleen C Loralr�_Yectranica*Signed)
(signature)
District Number 5655 Place North Creek, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 11 $ I Place of Disposition
W (address/
W
N (section) (tot nu m / (grave number)
IM
0 Name of Sexton or Person in Charge of Premises
p/ease print)
Z
LU Signature L Title
DO H-1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Rep.or License#
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