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Baudoux, Richard Warren Z NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Richard Warren Baudoux Male Date of Death Age If Veteran of U.S.Armed Forces, 03/26/2020 73 Years War or Dates 1966-1968 Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 17 Petrie Lane,Queensbury Town,New York 12804 p Manner of Death ©Natural Cause Accident Homicide ❑Suicide El Undetermined El Pending Circumstances Investigation W Medical Certifier Name Title John Lukaszewicz MD Address 101 Ridge Street 2,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 55 Burial Date Cemetery,Crematory or Facility Name 03/30/2020 Pine View Crematorium Entombment Address X❑Cremation Queensbury Town,New York 0 Donation ZO Removal Date Place Removed and/or and/or Held H N Hold Address O (L Date Point of V) ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition orto Whom 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 03/28/2020 Registrarof Vital Statistics Caroline 7fildegarde Barber(ECectronicaCCySigned) /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 H t /10 Place of Disposition i dfc`- LU /address/ 2 W Cl) (section) (lot num ) (grave number) Gir Ilt-41L, a Name of Sexton or Person in Charge of Premisesyw4 l Z /lease print/ W Signature Title DOH-1555(07/18)p 1 of 2 1" Public Health Law Sec. 4145(2b) 0 1 3 4 4 Receipt Human remains of `,si ,.. /,,x- delivered on 20 -u_ Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# __,