Tanner, Terry ;r , fr9d
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Terry Joseph Tanner Male
Date of Death Age If Veteran of U.S. Armed Forces,
August 2,2017 65 War or Dates
lam, Place of Death Hospital, Institution or
City, Town or Village Warrensburg Street Address 91 River Street,Apt. 1
pManner of Death [XI Natural Cause i Accident Homicide Suicide Undetermined - Pending
111 Circumstances Investigation
w Medical Certifier Name Title
.t ' Paul Bachman
Address
3767 Main Street,HHHN,Warrensburg,NY 12885
Death Certificate Filed District Number Register Number
City, Town or Village Warrensburg 5660
❑Burial Date Cemetery or Crematory
August 4,2017 Pine View Crematory
III Entombment
Address
❑x Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
O and/or Address
N Hold
Cl)
O Date Point of
u) Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
r Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
1- Remains are Shipped, If Other than Above
Address
tti
a. Permission is h re y granted to dispose of the hum remain described ab ve as in icated.
Date Issued [_T / Registrar of Vital Statisti C62
(si nature)
District Number 5660 Place Warrensburg
H
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition It /7 Place of Disposition Pry Q_ iii& .,,76/4cah,'v
Ill
(address)
CO
(section) l (lot numb r) (grave number)
p• Name of Sexton or o ' harge of Premises w/ rG.4 (c.
Z (please print)
illSignature , ,. Title rgrn of
(over)
DOH-1555 (02/2004)