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Remington Sr., Gerald
iI NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section 4 Burial Transit Permit Name First Middle Last Sex Gerald G. Remington,Sr. Male Date of Death Age If Veteran of U.S. Armed Forces, _, May 24,2017 73 War or Dates _' Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital UiManner of Death IXI Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation :L`1' Au: Medical Certifier Name Title 143:- Cleaver Address E uHIHIN Death Certificate Filed District Number Register Number 2 City, Town or Village Glens Falls 5601 2 ❑Burial Date Cemetery or Crematory May 30,2017 Pine View Crematory 0 Entombment Address ©Cremation 21 Quaker Rd. Queensbury, NY 12804 Date Place Removed 0 I I Removal and/or Held and/or Address H Hold Cl) O Date Point of N ' I Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address I Reinterment Date Cemetery Address 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 Remains are Shipped, If Other than Above Address L.° Permission is hereby granted to dispose of the human remains des ibed abo a icated. Date Issued c fJt j o✓7 Registrar of Vital Statistics X�g �^//�/ (signature) District Number $S(oO/ Place rZer.,o .- .1 , /1-)Y I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ILI• Date of Disposition 6 /1 117 Place of Disposition f 0� (,7r.� •r vr,i.- W (address) CO C O (section) ,/(lot amber) ( (grave number) p Name of Sexton or Person in Charge of Premises ` t„ J cyr►! W (ple se pent) Signature tof Title ratl112_ (over) DOH-1555 (02/2004)