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Kennedy Jr., John J. A 3sr NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John J.Kennedy Jr. I Male Date of Death Age If Veteran of U.S.Armed Forces, 04/09/2020 64Years War or Dates Il. Place of Death Hospital,Institution or W City,Town or Village WarrensburgTown Street Address 3826 Main Street,Warrensburg Town, New York 12885 [p Manner of Death ®Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation WMedical Certifier Name Title Paul Bachman MD Address 9 Carey Rd,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Warrensburg 5660 7 FjBurial Date Cemetery,Crematory or Facility Name 04/16/2020 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation z Removal Date Place Removed and/or and/or Held ~N Hold Address O a Date Point of N Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address 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 or to Whom II- 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 04/15/2020 Registrar of Vital Statistics (PameCa M GCoyd(�ECectronically Signed) (signature) District Number 5660 Place Warrensburg, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: /'y Fs lL wl o Z Date of Disposition y 116 110 Place of Disposition •• !0 W (address) 2 W CO) (section) (!ot number) (grave number/ c a Name of Sexton or Person in Charge of Premi /p ase print W Signature Zel!51- Title (�� -A DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#