Hanson, Mark Daniel -it 202
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Mark Daniel Hanson Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/06/2020 65 Years War or Dates
IN Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address 2 Windy Ridge Road,Glens Falls,New York 12801
W
pManner of Death ❑X Natural Cause El Accident Homicide ❑Suicide Undetermined El Pending
C.) Circumstances Investigation
W Medical Certifier Name Title
Roberta Miller Medicine
Address
16 Crimson Oak Ct,Schenectady,New York 12309
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 114
Burial Date Cemetery,Crematory or Facility Name
03/09/2020 Pine View Crematory
Entombment Address
0 Cremation Queensbury Town, New York
Donation
z Removal Date Place Removed
and/or and/or Held
H N Hold Address
O
a N �Transportation Date Point of
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
in Reinterment
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
Remains are Shipped,If Other than Above
Address
Ilr
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/09/2020 Registrar of Vital Statistics gWertgnfrewCurtu(EYectrvnicallySyzed�
-o (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:
H
WDate of Disposition 110 Place of Disposition i`/>—o—
LU (address)
W
W (section) (lot number) (grave number)
aName of Sexton or Person in Charg of Premises t`�
(Z ease print
W Signature Title 1prrra�}�
DO H-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) Fa C
Receipt
Human remains of ' ' delivered on , 20
Pine'View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# 1