Franklin Sr., Joseph 4 ;
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
tiz Joseph J.Franklin Sr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
I i
10/07/2018 86 Years War or Dates Korea
Place of Death Hospital, Institution or
City, Town or Village Johnsburg Town Street Address Elderwood at North Creek
Manner of Death 0 Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
'.--` Medical Certifier Name Title
James Hindson MD
Address
' - 112 Ski Bowl Rd,Johnsburg Town,New York 12853
Death Certificate Filed District Number Register Number
ittCity, Town or Village North Creek 5655 27
❑Burial Date Cemetery or Crematory
10/10/2018 Pine View Crematory
❑Entombment Address
titit
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
: : and/or Address
Hold
4` Date Point of
❑Transportation Shipment
by Common Destination
ilp Carrier
;'❑Disinterment Date Cemetery Address
pry"
ii,❑Reinterment Date Cemetery Address
til
pi Permit Issued to Registration Number
Of 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
sit Remains are Shipped, If Other than Above
Irv; Address
L
$vilt.l Permission is hereby granted to dispose of the human remains described above as indicated.
iit
kr Date Issued 10/09/2018 Registrar of Vital Statistics Nath(een C.Lorah(ECectronica1CySigned)
(signature)
District Number 5655 Place North Creek, New York
i'
s, I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition /D lit Il g Place of Disposition 'K.iL, l rw cad"
4 (address)
yy.
(section) lot number) r (grave number)
Name of Sexton or Person in Charge of Premises _ i n.- k.� ,)4....60
(ple4se print)
re
Signature 4 47 Title Of 4 P>1
(over)
DOH-1555 (02/2004)