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Smith Jr., Edward C.
� 30� NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Edward C Smith Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, 04/02/2020 87 Years War or Dates F,. Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 71 Longview Drive,Queensbury Town, New York 12804 pManner of Death © Natural Cause Accident Homicide Suicide Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title G Mary Stein NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 62 Burial Date Cemetery,Crematory or Facility Name 04/03/2020 Pine View Crematory Entombment Address Cremation Queensbury Town,New York Donation z Removal Date Place Removed and/or and/or Held H Hold Address N O IL Date Point of U) Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address Ej 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 orto Whom I— Remains are Shipped,If Other than Above Address Q W (L Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/03/2020 Registrar of Vital Statistics Caroline 96(degarde Barber(Electronically Signed) (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 y_ _ Place of Disposition W (address) M W N (section) (lot number/ (grave number) O Name of Sexton or Person in Charge of P ises f�1 I' ease print) W Signature Title DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) 013503 Receipt Human remains of delivered on , 20 Re sentin'-the'fu"nera home named on burial permit Pine View Cemetery p 8 Official Funeral Directors Reg.or License#