Webster, David y . ,, -zr 96)
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
`' Name First Middle Last Sex
David S. Webster Male
Date of Death Age If Veteran of U.S. Armed Forces,
April 2,2018 49 War or Dates
j,,,, Place of Death Hospital, Institution or
Z City, Town or Village Warrensburg Street Address 14 Oak Street
aManner of Death I Xl Natural Cause I I Accident j j Homicide I I Suicide Undetermined Pending
Ui Circumstances Investigation
u
i Medical Certifier Name Title
ifl Michael R.Bell MD
Address
HHHN,Warrensburg,NY 12885
- Death Certificate Filed District Number Register Number
City, Town or Village Warrensburg 5660
❑Burial Date Cemetery or Crematory
04-09-18 Pine View Crematory
❑Entombment Address
Ix Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
ZO I 1 Removal and/or Held
and/or Address
t Hold
N
0 Date Point of
N 1 I Transportation Shipment
p by Common Destination
Carrier
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 Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
g Address
tY
ul
Permission is hereby granted to dispose of the human remains�dj cribed above as indicated.
Date Issued 4-5-18 Registrar of Vital Statistic - U (/-c✓ `44----'
(signature)
District Number 3-60 Place T/O Warrensburg,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 4/ g /e Place of Disposition ?dieU , -i t '7
2 r (address)
W
co
Q.' (section) ! otHmber >` (grave number)
Op Name of Sexton or Perso in Charge of Premises h Gr„1 �
Z (please print)
w Title I-�Q. t n ale,.,--
Signaturelij
(over)
DOH-1555 (02/2004)