Sander Henry Christian #P3
NEW YORKSTATE DEPARTMENT OF HEALTH - Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Henry Christian Sander
Date of Death Age If Veteran of U.S.Armed Forces,
02/22/2020 94 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Queensbury Town Street Address 344 Glen Lake Road,Queensbury Town,New York 12845
p Manner of Death 0 Natural Cause Accident Homicide Suicide Undetermined Pending
(Wj Circumstances Investigation
WD Medical Certifier Name Title
Sharon Shannon NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 28
❑Burial Date Cemetery,Crematory or Facility Name
02/24/2020 Pine View Crematory
Entombment Address
x❑Cremation Queensbury Town,New York
Donation
OZ Removal Date Place Removed
and/or and/or Held
v-
N Hold Address
O
d Date Point of
N Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment I Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped,If Other than Above
Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/24/2020 Registrar of Vital Statistics Ca vt ne.Wi-fdegarde(Bar&r(EYe<tro-walySrgrreq)
(signature)
District Number 5657 Place Queensbury, 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 2 17L,110 Place of Disposition (,r. /,7roriU
W
2 (address)
W
N Q (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises �•
Z (piebseprintl
W Signature Title
Lol-
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) -1.. 3'
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#