Colton, Herbert V. NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Herbert V.Colton Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/25/2020 90 Years War or Dates 1951-1952
Place of Death Hospital,Institution or
W City,Town or Village Valatie Village Street Address Barnwell Nursing And Rehabilitation Center
in W Manner of Death ®Natural Cause Accident Homicide Suicide Undetermined Pending
' Circumstances Investigation
U
W Medical Certifier Name Title
Kathleen Steiger NP
Address
3230 Church St,Valatie Village,New York 12184
Death Certificate Filed District Number Register Number
City,Town or Village Valatie Village 1023 6
❑Burial Date Cemetery,Crematory or Facility Name
02/28/2020 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0 ❑Removal Date Place Removed
and/or and/or Held
F N Hold Address
0
0. Date Point of
N ❑Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
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 or to Whom
_ Remains are Shipped,If Other than Above
Address
R
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/27/2020 Registrar of Vital Statistics Barbara Ann fischer(ECectronicallySigner)
(signature)
District Number 1023 Place Valatie Village, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
l
WDate of Disposition 1 ]� 10 Place of Disposition 6. rt`
2 (address)
W
N (section) (lot number) (grave number)
X
Q Name of Sexton or Person in Charge of Premises to
Z , (p ase print)
W Signature Title
DOH-1555(07/18)p 1 of 2
74,
Public Health Law Sec. 4145(2b) "� h
Receipt
Human remains of delivered on , 20
t
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#