Nedwick, Donald f r . 411 519,c
NEW YORK STATE DEPARTMENT OF HEALTH k Vital Records Section Burial - Transit Permit
5 Name First MI Cldle Last Sex
Donald R.Nedwick Male
Date of Death Age If Veteran of U.S. Armed Forces,
-- 07/10/2018 90 Years War or Dates WWII
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death El Natural Cause 0 Accident Homicide ID Suicide El Undetermined ri Pending
Circumstances Investigation
Medical Certifier Name Title
William Cleaver MD
; Address
100 Park St,Glens Falls,New York 12801
1.1 Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 341
s❑Burial Date Cemetery or Crematory
07/13/2018 Pine View Crematory
❑Entombment Address
A.
®Cremation Queensbury Town, New York
41
Date Place Removed
;a:❑Removal and/or Held
: and/or Address
Hold
Date Point of
Q Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
ReintermentA.
Date Cemetery Address
Permit Issued to Registration Number
sfi Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
-_ Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
n Date Issued 07/12/2018 Registrar of Vital Statistics Rp6ertA Curtis(ElectronicallySigned)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance withthis permit on:
El
Date of Disposition 7/'l3 j f d Place of Disposition �rr U . [,•y„ }o n,,.,,
(address)
(section) t number) (grave number)
1++�.c S
Name of Sexton or Person in Charge of remises r„#10 tnml fi
rill
/;� (plea print)
Signature �"' Title ON"
(over)
DOH-1555(02/2004)