Baker, Eugene J 71 NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Eugene Edward Baker Male
Date of Death Age If Veteran of U.S. Armed Forces,
02/27/2018 48 Years War or Dates Army
Place of Death Hospital, Institution or
City, Town or Village Albany Street Address Albany Medical Center Hospital
Manner of Death K❑Natural Cause ❑Accident ❑Homicide Suicide riUndetermined El 1—"Investigation
Pending
Circumstances
Medical Certifier Name Title
Joseph Young MD
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City, Town or Village Albany 0101 0486
CI Burial Date Cemetery or Crematory
03/05/2018 Pine View Crematory
DEntombment Address
®Cremation Queensbury, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,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 03/01/2018 Registrar of Vital Statistics rDanie/iiSccilrespie(EkctronicallySigned)
(signature)
District Number 0101 Place Albany, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 3 it,i't Place of Disposition �,�tl.✓ /". ..,,1e
(address)
(section) pi(lot number) ` (grave number)
Name of Sexton or Person in Charge of Premises :y
(pass print)
Signature Title IP4L
(over)
DOH-1555 (02/2004)