Swan, Barry R. 0 031
NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Barry R.Swan Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/17/2019 73 Years War or Dates Vietnam
Place of Death Hospital,Institution or
Z City,Town or Village Warrensburg Town Street Address 82 Library Avenue,Warrensburg Town,New York 12885
pManner of Death FR Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
W Circumstances Investigation
WMedical Certifier Name Title
Paul Bachman MD
Address
9 Carey Rd,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Warrensburg 5660 23
❑Burial Date Cemetery,Crematory or Facility Name
❑Entombment
12/20/2019 Pine View Crematory
Address
Cremation Queensbury Town,New York
❑Donation
0 ❑Removal Date Place Removed I
and/or and/or Held
t—N Hold Address
d Date Point of
f/A ❑Transportation Shipment I
p by Common
Carrier Destination
❑
Disinterment Date Cemetery Address
I
❑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 orto Whom
Remains are Shipped,If Other than Above
Address
cc
[' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/19/2019 Registrar of Vital Statistics DDmaa,4ComAs(Ekctronkaf St wq)
(signature/ j
I
District Number 5660 Place Warrensburg, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
Z Date of Disposition 12 j to j JS Place of Disposition ix 011
� (address)
W
N (section) (lotnumber/ (grave number)
I=
G Name of Sexton or Person in Charge of Premises
(p se print
W Signature Title
DOH-1555(o7/18)p 1 of z j
I
i
Public Health Law Sec. 4145(2b) 013164,
Receipt
Human remains of �r .,.,_y delivered on 20 /
e
Pine View Cemetery Representing the funeral home named on burial permit
y
Official Funeral Directors Reg.or License# i
I
I
i
I