Alexander, Kent Clay NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Kent Clay Alexander Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/05/2019 1 54 Years War or Dates Navy
�,. Place of Death Hospital,Institution or
WCity,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
p Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances investigation
W Medical Certifier Name Title
Jean Flanagan MD
Address
319 Broadway,Fort Edward Town,New York 12828
Death Certificate Filed District Number Register Number
City,Town or Village Fort Edward 5755 104
❑Burial Date Cemetery,Crematory or Facility Name
12/10/2019 Pine View Crematory
Entombment Address
KCremation Queensbury,New York
❑Donation
z Removal Date Place Removed
O and/or and/or Held
as Hold Address
O Date Point of
❑Transportation Shipment
by Common
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 Other than Above
Address
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/09/2019 Registrar of Vital Statistics ,*i weMalroney(--kctronrcad Sagnerl�(signature/
District Number 5755 Place Fort Edward, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition IL I1015 Place of Disposition (address/
2
W
(sedan) '(lot number/ (grave number)
111C1�1 IT
gName of Sexton or Person in Charge of Premises t t-s L
Z � .�� lease print
W Signature Title
DOH-1555(o7/18)p t of 2
Public Health Law Sec. 4145(2b) 0 13 13 8
Receipt
Human remains of - 1- '� G` �'delivered on - , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# i . t7
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