Webster, Charles NEW YORK STATE DEPARTMENT OF HEALTH G --- 37io
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Charles E. Webster Male
Date of Death Age If Veteran of U.S. Armed Forces,
May 8,2018 69 War or Dates Vietnam
Place of Death Hospital, Institution or
City, Town or Village Warrensburg Street Address 21 Summit St.
` Manner of Death Undetermined Pending
Natural Cause n Accident Homicide Suicide
Circumstances Investigation
us Medical Certifier Name Title
O Paul Bachman
Address
3767 Main Street,HHHN,Warrensburg,NY 12885
Death Certificate Filed District Number Register Number
City, Town or Village Warrensburg 5660
❑Burial Date Cemetery or Crematory
Entombment May 10,2018 Pine View Crematory
Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
52 and/or Address
H Hold
CO
O Date Point of
coTransportation 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
1- Remains are Shipped, If Other than Above
E. Address
Ce
I LI
n`' Permission is h re y granted to dispose of the human re ains described above as indicated.
Date Issued ,� 1 Registrar of Vital Statistics �,�o, A. C v b S
(signature)
District Number 5660 Place Warrensburg
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
• Date of Disposition C/ic ils Place of Disposition g��.� .1.c1.
W (address)
cn
cc (section) A(lot numb ) (grave number)
pName of Sexton or Person in Charge of Premises f t .tp�li, �y.-44
Z (p/base print)
W Signature 4 4 Title MOP-WIC
(over)
DOH-1555 (02/2004)