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Bauer, David NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex David Bauer Male Date of Death Age If Veteran of U.S.Armed Forces, 12/22/2019 76 Years War or Dates Place of Death Hospital,Institution or Uj Z City,Town or Village Valatie Village Street Address Barnwell Nursing And Rehabilitation Center 0 Manner of Death ©Natural Cause �Accident �Homicide �Suicide �Undetermined �Pending CUj Circumstances Investigation Medical Certifier Name Title Ronald Gross MD Address 3230 Church St,Valatie Village,New York 12184 Death Certificate Filed District Number Register Number City,TownorVill a Valatie Village 1023 69 ©Burial Date Cemetery,Crematory or Facility Name 12/27/2019 Pine View Cemetery Entombment Address Cremation Queensbury Town,New York Donation pRemoval Date Place Removed 0 and/or and/or Held N Hold Address R U) ❑Transportation Date Point of S by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Otherthan Above Address Q W d Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/24/2019 Registrar of Vital Statistics Bar6ara,4nn Tischer(ECectronicalCySigned) (signature/ District Number 1023 Place Valatie Village, New York t I certify that the remains of the decedent identified above were disposed of in accordance with this per on: W Date of Disposition /D 0?7 f 9 Place of Disposition Z/ c !address/ W / /S lion/ (!ot number) (grave number/ O Name of Sext r Person in Charge 9f Qremises C-�� t% 7 0 L-�j t Z J /ease print/ W Signature G Tit[� DOH-1555(07118)p 1 of 2 Public Health Law Sec. 4145(2b) 010360 Receipt Human remains of delivered on , 20_ e mew Cemetery Representing.the funeral home named on burial permit Official Funeral Directors Reg.or License# v. NAME David Bauer Age: 76 Lot Owner: David and Louis Bauer Lot# 20E Horicon Grave# 1 Case: Concrete Died: Interred: 12/22/2019 12/27/19 Funeral Home: Regan Denny Stafford Funeral Home Cemetery: Pine View Cemetery