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Vanderwarker, Ralph H.
-#/S8 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Ralph H.Vanderwarker Male Date of Death Age If Veteran of U.S.Armed Forces, 02/18/2020 55 Years War or Dates II.- Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital LU p Manner of Death ©Natural Cause El Accident Homicide Suicide Undetermined Pending tU Circumstances Investigation U Title W Medical Certifier Name 0 Asim Chaudry MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 85 Burial Date Cemetery,Crematory or Facility Name 02/20/2020 Pine View Crematory Entombment Address MCremation Queensbury Town,New York Donation Date Place Removed 0 Removal and/or Held H and/or Address N Hold dDate Point of to Transportation Shipment p by Common Carrier Destination Date Cemetery Address Disinterment Date Cemetery Address 1EIReinterment Registration Number Permit Issued to Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500,Lake Luzerne,New York 12846 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Otherthan Above 2 Address W W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/19/2020 Registrar of Vital Statistics Robert Andrew Curtis(Electronically Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: /� ~ Z (°a-�-d rL— Z Date of Disposition /71 17o Place of Disposition �w (address) W N (section) (lot nu er) (grave number) Q O 0 Name of Sexton or Person in Charge of Premises (please print) z /U f W Signature -"r Title DOH-1555(07/18)p t of 2 I Public Health Law Sec. 4145(2b) 013354 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#