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Raymond, Stephen NEW YORK STATE DEPARTMENT OF HEALTH 4 Vital Records Section Burial - Transit Permit N. ` Name First Middle Last Sex Stephen L. I Raymond Male :. Date of Death Age If Veteran of U.S. Armed Forces, a April 17,2017 67 War or Dates Vietnam Place of Death Hospital, Institution or City, Town or Village Thurman Streets...--`75 Cameron Road Manner of Death g Natural Cause Accident Homicide Suicide Undetermined Pending f m Circumstances Investigation Medical Certifier Name Title G' Aqeel Gillani Address CR Wood Cancer Center, 102 Park St.,Glens Falls,NY 12801 _` Death Certificate Filed District Number Register Number City, Town or Village Thurman _ 5659 ClE ❑Burial Date Cemetery or Crematory April 19,2017 Pine View Crematory ❑Entombment Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed Z Removal and/or Held 9 and/or Address \__i F" Hold CO 0 Date Point of y F 1 Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address ::%,' Permit Issued to Registration Number _. Name of Funeral Home Alexander-Baker Funeral Home 00037 Address rk 3809 Main Street,Warrensburg,NY 12885 Name of Funeral Firm Making Disposition or to Whom 1.4..", Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remai described above as indicated. Date Issued O V-/9-/9 Registrar of Vital Statistics ,u,,C__.._ signature) District Number`-'-6,8-7 Place ldn o 722 o✓ma x, V I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z gAit......./ w Date of Disposition q'ipl f, Place of Disposition eln-fig,$of is--, 2 (address) CO CC (section) 1 (lot number) (grave number) pName of Sexton or Person in Charge of Premises riL- OMI1 wZ ase priry Signature Title -�� (over) DOH-1555 (02/2004)