Moses, Richard NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
.- Name First Middle Last Sex
Richard B.Moses Male
Date of Death Age If Veteran of U.S. Armed Forces,
06/14/2018 60 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Albany Street Address Albany Medical Center Hospital
m. Manner of Death 0 Natural Cause ❑Accident ❑Homicir'e ❑Suicide ❑Undetermined ❑Pending
rt Circumstances Investigation
Hi Medical Certifier Name Title
ti. Tara Fitzgerald NP
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed rict Number Register Number
City, Town or Village Albany I oI°I 1304
❑Burial Date Tietery or Crematory
06/18/2018 View Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
Date .;e Removed
El❑Removal a/or Held
and/or Address
b Hold "'
Date Point of
❑Tti) ransportation Shipment
by Common Destination
Carrier _
Date CemeteryAddress
r ❑Disinterment
4
❑Reinterment Date Cemetery Address
_' Permit Issued to Registration Number
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
amOt
Address
N.
Permission is hereby g dispose to dis ose of the human remains described above as indicated.
Date Issued 06/15/2018 Registrar of Vital Statistics DanielleSGi((espie(E(ectronica1CySigned)
(signature)
District Number Place
0101 Albany, New York
4
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition b/19 ill Place of Disposition ,2,"„(i„J iswgio,,..,
(address)
W.
CO
(section) 1 number) (grave number)
in Name of Sexton or Person in Charge of remises (k U' 4*
Z.
(pleas print)
LLI
Signature �` Title fa Oil P
(over)
DOH-1555 (02/2004)