Read, Scott NEW YORK STATE DEPARTMENT OF HEALTH or , I
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Scott G. Read Male
Date of Death Age If Veteran of U.S. Armed Forces,
October 11,2018 64 War or Dates NA
Place of Death Hospital, Institution or
Z City, Town or Village Moreau Street Address 63 Wineberry Lane,Ballston Spa
p Manner of Death I XI Natural Cause 1 Accident [ I Homicide F 1 Suicide Undetermined Pending
uJ° Circumstances Investigation
W Medical Certifier Name Title
0; Eugene Merecki MD
Address
6 Medical Park Dr.,Malta,NY 12020
Death Certificate Filed District Number Register Number
City, Town or Village 04144 �Slo� E
❑Burial Date Cemetery or Crematory
October 16,2018 Pine View Crematory
❑Entombment Address
1l Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
ZO I I Removal and/or Held
and/or Address
H Hold
Cl) _
O Date Point of
NI I Transportation Shipment
p by Common Destination
Carrier
Disinterment Date I 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
2 Address
Permission is hereby granted to dispose of the human remai s escrib d bv3 S in icated.
Date Issued `(DVS,ZrAe) Registrar of Vital Statistics
(signet re)
District Number y Place 0 �\�-c+.�_
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Lu• Date of Disposition Ipll>+�Ig Place of Disposition „k�,�, �,,,�10f,,�
(address)
(section) lot number) (grave number)
Q Name of Sexton or Person in Charge of Premises Vir,1 1,"'ri
Z (please print)
W
Signature / Title
(over)
DOH-1555 (02/2004)