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Murray Jr., Roger NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit PermitVital Records Section : Name First Middle Last Sex Roger J. Murray,Jr. Male Date of Death Age If Veteran of U.S. Armed Forces, July 10,2017 52 War or Dates • Place of Death Hospital, Institution or City, Town or Village Chester Street Address 88 Friends Lake Road ,ti Manner of Death Undetermined Pending Natural Cause Accident Homicide X Suicide .tom Circumstances Investigation jI Medical Certifier Name Title 0 William Orluk Pip Address Chester Health Center,Chestertown,NY 12817 Death Certificate Filed District Number Register Number City, Town or Village T/O Chester 5652 I Q ❑Burial Date Cemetery or Crematory El Entombment July 12,2017 1 Pine View Crematory Address 0 Cremation 21 Quaker Rd., Queensbury, NY 12804 Date 1 Place Removed Z Removal and/or Held and/or Address H Hold co O Date Point of a. Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address • ';° Permit Issued to I 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 =t*:3 Remains are Shipped, If Other than Above . Address Permission is hereby granted to dispose of the human re inti described above as indicated. • `: Date Issued r1-,11�'Q ©1-1 Registrar of Vital Statistics 1(( ( 'gnature) �` � �V1 ' District Number J(off. Place 1 0�,�,, o` r- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition )) 11 I Place of Disposition -fix Op./ iw+Ta"10t+6..- 2 (address) W 0 Ce (section) (lot number) (grave number) O p Name of Sexton or Person in Charge of Premises Ar;, SutiNf- Z (pleake print) W Signature I ZZe Title C (over) DOH-1555 (02/2004)