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Steady, John # Zy NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit s .,: Name First Middle Last Sex John Henry Steady Male ' Date of Death Age If Veteran of U.S. Armed Forces, , 03/21/2018 86 Years War or Dates Korea Place of Death Hospital, Institution or City, Town or Village Granville Village Street Address Indian River Rehabilitation And Nursing Center v Manner of Death©Natural Cause 0 Accident El Homicide El Suicide 0 Undetermined ri Pending Circumstances Investigation 4, Medical Certifier Name Title Sean Bain MD iii Address 17 Madison St,Granville Village,New York 12832 M. Death Certificate Filed District Number Register Number ;Z City, Town or Village Granville Village - 5725 12 1 ❑Burial Date Cemetery or Crematory 03/22/2018 Pine View Crematory ❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed :z❑Removal and/or Held and/or Address Hold Date Point of Q Transportation Shipment by Common Destination '; Carrier Q 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 • Remains are Shipped, If Other than Above ram. Address ,. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/22/2018 Registrar of Vital Statistics WichareRo6erts(E(ectronicatlySigned) (signature) District Number 5725 Place Granville Village, New York =' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 3126l1t Place of Disposition F�11.-- (Lt._ (address)ry (section) "lot number) (grave number) Name of Sexton or Person in Charge of Premises % 'ii0 - (plebse print) �. Signature !� �.� Title 1.0 cr+mn (over) DOH-1555 (02/2004)