Richardson, John F. 4t s�
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
John F.Richardson Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/14/2020 60 Years War or Dates
II.- Place of Death Hospital,Institution or
WCity,Town or Village WarrensburgTown Street Address 18 Raymond Lane,Warrensburg Town, New York 12885
WManner of Death IN NaturalCause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
Frances Bollinger MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Albany 8888
❑Burial Date Cemetery,Crematory or Facility Name
01/16/2020 Pine View Crematory
Entombment Address
LAU Cremation Queensbury Town,New York
Donation
0z ❑Removal Date Place Removed
and/or and/or Held
N
Hold Address
O
IL Date Point of
to ❑Transportation
p by Common Shipment
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
X
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/15/2020 Registrar of Vital Statistics 914aryE•xefner(ElectronicaffySigned)
(signature)
District Number 8888 Place Albany, 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 Zo Place of Disposition 1k fu—
LLJ (address)
W
N f (section) (lot number) (grave number)
41 0 Name of Sexton or Person in Charge of Premises f' al
Z (p ase print)
W Signature Title
DO H-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 9 1 3?4 7
Receipt
Human remains of delivered on , 20
;f
Pine View Cemetery Rep ting the funeral home named on burial permit
Official Funeral Directors Reg.or License#