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Allen, Edward NEW YORK STATE DEPARTMENT OF HEALTH . 1, Vital Records Section Burial - Transit Permit Name First Middle Last Sex Edward William Allen - Male Date of Death Age If Veteran of U.S. Armed Forces, 03/24/2018 63 Years War or Dates Place of Death Hospital, Institution or City, Town-or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause 0 Accident 0 Homicide Q Suicide ri Undetermined ri Piending Circumstances Instigation Medical Certifier Name Title Nawed Siddiqui MD Address 100 Park St,Glens Falls,New.York-12801 Death Certificate Filed District Number - . 'R terL umber . p City, Town or Village Glens Falls .,,5601 15 ' ❑BUrial Date Cemetery or Crematory ' ;,-, 03/27/2018 Pine View Crematory &s❑Entombment Address - ®Cremation Queensbury Town, New York . Date Place Removed ri Removal and/or Held V and/or Address Hold `-,x Date Point of ❑Transportation Shipment by Common Destination Carrier 0 Disinterment Date Cemetery Address ?;tFY 0 Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 - Address 1 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 03/26/2018 Registrar of Vital Statistics cp6ertA Curtis(Efectranically Signed) (signature) District Number 5601 Place Glens Fails, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 317)II$ Place of Disposition KVf (, - (address) (section) (lot numb f (grave number) Name of Sexton or Person in Charge Premises (please print) dSignature l Title /W (over) DOH-1555(02/2004)