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Strodel, Douglas M. S. _ NEW YORKSTATE DEPARTMENT OF HEALTH - �3�Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Douglas M.Strodel Male Date of Death Age If Veteran of U.S.Armed Forces, 12/31/2019 75 Years War or Dates 1965-1969 Place of Death Hospital,Institution or Z City,Town or Village Warrensburg Town Street Address 744 Schroon River Road,Warrensburg Town,New York 12885 pManner of Death Natural Cause ©Accident ❑Homicide ❑Suicide EjUndetermined Pending VCircumstances Investigation W Medical Certifier Name Title Connie Goedert Coroner Address 1400 St Route 9,Lake George Town, New York 12845 Death Certificate Filed District Number Register Number City,Town or Village Albany 8888 ❑Burial Date Cemetery,Crematory or Facility Name 01/10/2020 Pine View Crematory Entombment Address MV IX 1 Cremation Queensbury Town,New York Donation 0 a Removal Date Place Removed and/or and/or Held H Hold Address N dDate Point of UN ❑Transportation Shipment G 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 IF- Remains are Shipped,If Other than Above Address W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/09/2020 Registrar of Vital Statistics MaryE..7fefner(ECectronicallySiyned) (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: Z ` Date of Disposition �U Zo Place of Disposition tcu— Uj Uj (address) W N (section) (tot number/ (grave number) GName of Sexton or Person in Charge of Premises (p/ se print) Z W Signature Title DOH-1555(o7/18)p t of 2 I Public Health Law Sec. 4145(2b) 13 2'A 6 Receipt Human remains of delivered on , 20— da f if a Pine View Cemetery Repr enting tf)e funeral home named on burial permit Official Funeral Directors Reg.or License# i i j