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Studdiford Jr., Andrew . /133b NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex ry Andrew Douglass Studdiford Jr. Male 711i. Date of Death Age If Veteran of U.S.Armed Forces, _, - 04/10/2018 86 Years War or Dates 1951-1952 Place of Death Hospital, Institution or -'"s Ci Town or Village Glens Falls Street Address Glens Falls Hospital City, 9 Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending "` Circumstances Investigation Ln Medical Certifier Name Title Jennifer Stratton MD ... Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number g Ci , Town or Villa•e Glens Falls 5601 205 ❑Burial Date Cemetery or Crematory fit04/23/2018 Pine View Crematory ❑Entombment Address Ad®Cremation Queensbury Town, New York Date Place Removed ,:u❑Removal and/or Held and/or Address 4 Hold Date Point of Q Transportation Shipment J by Common Destination Carrier ❑Disinterment Date Cemetery Address A❑Reinterment Date Cemetery Address .r.g 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 ' 4 Remains are Shipped, If Other than Above `: Address alal Permission is hereby granted to dispose of the human remains described above as indicated. 04? Date Issued 04/23/2018 Registrar of Vital Statistics Rp6ertA Curtis(E(ectronica1TySigned) (signature) to District Number 5601 Place Glens Falls, New York rt Ai x 4' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: =A.j Date of Disposition y�2 ��Q Place of Disposition et.V-... 4044o :,,,—, r d (address) (section) (lot number) (grave number) Name of Sexton or Person in Charge of P emises (1n. S.4-a114' "., f ( ease print) 94,4 Signature Title (Rom (over) DOH-1555(02/2004)