Richards, Maurice E.. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Maurice E.Richards Male
Date of Death Age If Veteran of U.S.Armed Forces,
`E 11/25/2019 93 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Johnsbur Town Street Address Elderwood at North Creek
p' Manner of Death ®Natural Cause Accident Homicide ❑Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Madison Zuis NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village North Creek 5655 48
Burial Date Cemetery,Crematory or Facility Name
12/03/2019 Pine View Crematory
❑Entombment Address
Cremation Queensbury Town,New York
Donation
ORemoval Date Place Removed
and/or and/or Held
N
Hold Address
O
a Date Point of
in ElTransportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment 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
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/29/2019 Registrar of Vital Statistics Wpthken C.Gorah(ECectronicaffySigned)
(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:
F-
Z Date of Disposition 12 13111 Place of Disposition ,i r,,`
uj (address)
UJI
N (section) /f lot number/ (grave number)
Ir C0' Name of Sexton or Person in Charge of Premises ��
(plea print)
Signature /�� Title r
hyp
DO H-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt ;
Human remains of delivered on .. , 2C
. f
Pine View Cemetery Representing the funeral home named on burial pe
Official Funeral Directors Reg.or License# `