Vega, Paul Lee _ 4 30
NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Paul Lee Vega Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/08/2020 77 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W
'p Manner of Death Natural Cause Accident Homicide Suicide Ej Undetermined Ej Pending
V Circumstances Investigation
0 Medical Certifier Name Title
Kyle Leonard MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 17
Burial Date Cemetery,Crematory or Facility Name
01/10/2020 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
~ Hold Address
O
IL Date Point of
CO) Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
f.. Remains are Shipped,If Other than Above
Address
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/09/2020 Registrar of Vital Statistics XP6en�?ndrew Curtis(!ElectrvnicallySyneq)
(signature/
District Number 5601 Place Glens Falls, 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 -to
W Place of Disposition (V-
2 (address)
W
N (section) t number/ (grave number)
GName of Sexton or Person in Charge ofgremises fAL,,— l
Z (plea print)
W lR �D2
Signature �.t6" Title
DOH-1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2b) 013224
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing i6i funeral home named on burial permit
Official Funeral Directors Reg.or License#