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Knoll, Andrew NEW YORK STATE DEPARTMENT OF HEALTH f ' Io Vital Records Section Burial - Transit Permit Name First Middle Last Sex Andrew L. Knoll Male Date of Death Age If Veteran of U.S. Armed Forces, March 6,2017 52 War or Dates Place of Death Hospital, Institution or g. City, Town or Village Glens Falls Street Address Glens Falls Hospital F ' Manner of Death x Natural Cause Accident I I Homicide Suicide Undetermined Pending Circumstances Investigation tti, Medical Certifier Name Title 0" Paul Bachman MD Address 3767 Main Street,HHHIN,Warrensburg,NY 12885 Death Certificate Filed District Number Register N er 70 City, Town or Village CIO Glens Falls 5601 ❑Burial Date Cemetery or Crematory March 7,2017 Pine View Crematory 0 Entombment Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed Z Removal and/or Held and/or Address N Hold 0 Date Point of NTransportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address •, Permit Issued to Registration Number spun' Name of Funeral Home Alexander-Baker Funeral Home 00037 Address ' 3809 Main Street,Warrensburg,NY 12885 E-_''`a Name of Funeral Firm Making Disposition or to Whom IM Remains are Shipped, If Other than Above ' Address ttJ« Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 3 f"-1 I I -I Registrar of Vital Statistics .�"--C trkgr (signature) District Number 5601 Place C/O Glens Falls,NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: uiDate of Disposition '/$/1l Place of Disposition 'en eYIN/ into(;,,_.. W (address) ca pcC (section) `//(lot number) c (grave number) Name of Sexton or Person in Charge of P emises L/►ns r ..)& lit Z (ple sse print) W Signature tL Title 113ll411 (over) DOH-1555 (02/2004)