Loading...
Merkel, Gerald Michael NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Gerald Michael Merkel Male Date of Death Age If Veteran of U.S.Armed Forces, 01/22/2020 67 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Horicon Town Street Address 7790 State Route#8 Route,Horicon Town,New York 12815 p Manner of Death ©Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title G Connie Goedert Coroner Address 1400 St Route 9,Lake George Town,New York 12845 Death Certificate Filed District Number Register Number City,Town or Village Brant Lake 5654 3 Burial Date Cemetery,Crematory or Facility Name 01/25/2020 Pine View Crematorium Entombment Address Cremation Queensbury Hamlet,New York Donation ZO Removal Date Place Removed and/or and/or Held H N Hold Address dDate Point of U) Transportation Shipment Q by Common Carrier Destination El Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom I— 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 01/24/2020 Registrar of Vital Statistics xnsta L Wood(E(ectronicaQy Signed) (signature) District Number 5654 Place Brant Lake, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition k a —Lp?V Place of Disposition Je— 1t.2rt, W (sedan) 1 llot umbe (grave number) Name of Sexton or Person in Cha a of P mi s a ' ' please print)Z W Signature �� Title DOH-1555(o7/18)p t of 2 Public Health Law Sec. 4145(2b) 01 ;S 2 7 Receipt Human remains of �" d f !�.! delivered on Pine View Cemetery "Representing tWe funeral home named on burial permit Official Funeral Directors Reg.or License °