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Collier, Larry D.
� Z3� NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Larry D.Collier Male Date of Death Age If Veteran of U.S.Armed Forces, 03/06/2020 63 Years War or Dates F Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death © Natural Cause Accident Homicide Suicide ❑Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title 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 117 Burial Date Cemetery,Crematory or Facility Name 03/13/2020 Pine View Crematory Entombment Address Cremation Queensbury Town,New York Donation Z Removal Date Place Removed and/or and/or Held f- N Hold Address O G. Date Point of to ❑Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address FJ Reinterment I 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 I— Remains are Shipped,If Other than Above Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/10/2020 Registrar of Vital Statistics wpbert 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: Date of Disposition 3-1 - Place of Disposition 211�e W (address W N (seaion) (lot numbe (grave number) g Name of Sexton or Person in Charge of Premise ^� (please print) W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) •- . _ 013431 Receipt A Human remains of delivered on , 20 t, -1 ne View Cemetery Representing the Mineral home named on burial permit Official Funeral Directors Reg.or License#