Erskine, Barry NEW YORK STATE DEPARTMENT OF HEALTH ` � '
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
~ Barry George Erskine Male
i;.
Date of Death Age If Veteran of U.S. Armed Forces,
10/20/2018 74 Years War or Dates Nat'l Guard
1 Place of Death Hospital, Institution or
City, Town or Village Albany Street Address Albany Medical Center Hospital
' ` Manner of Death Natural Cause El Accident Homicide ID Suicide �Undetermined Pending
Circumstances Investigation
Medical Certifier Name
Title
Rachel Le MD
43 Address
43 New Scotland Ave,Albany,New York 12208
``tom Death Certificate Filed District Number Register Number
. 0 0101 2346
-.-% City, Town or Village Albany
❑j, Burial
Date Cemetery or Crematory
;; 10/25/2018 Pine View Crematory
r'y.❑Entombment
Address
®Cremation Queensbury Town, New York
' Date Place Removed
::❑Removal and/or Held
and/or
Address
Hold
•
Date Point of
• ❑Transportation Shipment
- by Common Destination
, Carrier
'I' El Disinterment Date Cemetery Address
,,A Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
�g Address
11 Lafayette St,Queensbury,New York 12804
PA 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.
4 Date Issued 10/24/2018 Registrar of Vital Statistics Danielre S Clillespie(ECectronically Signed)
(signature)
It District Number 0101 Place
Albany, New York
a
Til I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition lb I t lig Place of Disposition fillet,- ( 11~--
(address)
, +.
(section) (lot nuTer) < (grave number)
'" Name of Sexton or Person in Charge of Premises L ir» iltr' Jo,,,i'
(please print
4 �E
� Signature Title
tilfITYL
(over)
DOH-1555 (02/2004)