Doetsch, Logan4611
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last
Sex
Logan H. Doetsch
I Male
Date of Death
Age
If Veteran of U.S. Armed Forces,
09/11/2019
32 Years
War or Dates
Place of Death
Hospital, Institution or
WCity,
Town or Village HadleyTown
Street Address 927 Stoney Creek Road, Hadley Town, New York 12835
C1
Manner of Death Natural Cause Accident Homicide ®Suicide Undetermined Pending
W
Circumstances Investigation
0
W
Medical Certifier Name Title
Susan Hayes -Mass Coroner
Address
40 McMaster Street, Ballston Spa, New York 12020
Death Certificate Filed
District Number
Register Number
City, Town or Village Hadley
4558
9
Burial
Date
Cemetery, Crematory or Facility Name
Entombment
09/19/2019
Pine View Crematory
Address
Cremation
Queensbury Town, New York
Donation
Removal
Date
Place Removed
❑
and/or Held
F-
and/or
Hold Address
N
O
IL
Date Point of
U)
Q
Transportation Shipment
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
Remains are Shipped, If Other than Above
Address
it
W
Ca'
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/16/2019 Registrar of Vital Statistics Pauline GSmead(ElectronicaCCySiyned)
(signature)
District Number 4558 Place Hadley, 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 9 tel 19 Place of Disposition Vi s,/
W
(address)
W
N
cc
(section) (lot number) (grave number)
0
Name of Sexton or Person in Charge of Premises `�
/ple a printl
W/,
Z— L gikP+�
Signature Title
DO H-1555 (07/18) p 1 of 2
Public Health Law Sec. 4145(2b)
i�1254'7
Receipt
Human remains of :> r, ; �t, a delivered on ' , 20 % -
kIL
Pine View Cemetery Represen ' e funeral home named on burial perm.
Official Funeral Directors Reg. or License #