Dunkley, Vincent L. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Vincent L.Dunkley Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/19/2020 78 Years War or Dates
I— Place of Death Hospital,Institution or
Z City,Town or Village Chester Town Warren Street Address 613 Bird Pond Road,Chester Town Warren,New York 12853
W Manner of Death Undetermined Pending
W ®Natural Cause Accident Homicide ❑Suicide g
Circumstances Investigation
W Medical Certifier Name Title
Ageel Gillani MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Chestertown 5652 5
❑Burial Date Cemetery,Crematory or Facility Name
03/23/2020 Pine View Crematory
Entombment Address
170
Lai Cremation Queensbury Town,New York
Donation
Q Removal Date Place Removed
and/or and/or Held
Hold Address
O
a Date Point of
fn ❑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 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
cc
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/21/2020 Registrar of Vital Statistics MintCy Conway(ECectmnicallySigned)
(signature/
District Number 5652 Place Chestertown, 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 —,ZD J Place of Disposition (, C rc
2 (address)
W
N (section) flat number) (grave number/
Name of Sexton or Person in Ch ge of Premise N
Z /please print)
W Signature Title
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) 0134 - S,
Receipt
Human remains of i delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#