Daniels, Alfred NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Alfred Beecher Daniels
Male
Date of Death Age If Veteran of U.S. Armed Forces,
03/29/2018 91 Years War or Dates 1944-1945
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
<.. Asim Chaudry MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 165
OBurial
Date Cemetery or Crematory
04/02/2018 Pine View Crematory
OEntombment-Address
®Cremation Queensbury Town, New York
Date Place Removed
I—IRemoval and/or Held
and/or Address
Hold
Date Point of
O Transportation _ Shipment
by Common Destination
Carrier
O Disinterment
Date Cemetery Address
O Reinterment Date Cemetery Address
``, Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
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.
Date Issued 04/02/2018 Registrar of Vital Statistics Rp6ert)Curtis(f(ectronically Signed)
(signature)
District Number 5601 Place
xt Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 41 It I Place of Disposition
(address)
r.- (section) E (lot number) (grave number)
Name of Sexton or Person in Charge of P emises n
( lease prin)
"14-
Signature Title
Wool treN
(over)
DOH-1555 (02/2004)