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Kennedy, Kenneth NEW YORK STATE DEPARTMENT OF HEALTH . 4'Ns.. # 270 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Kenneth _Kennard Kennedy Male Date of Death Age If Veteran of U.S. Armed Forces, 03/28/2017 79 years War or Dates 1:-- Place of Death Hospital, Institution or City,Xxxgt g( i j e Schenectady Street Address Ellis Hospital Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending IL/ Circumstances Investigation W Medical Certifier Name Title P Brian Mc Donald M D Address 124 Rosa Road, Suite 382, Schenectady, N Y12309 Death Certificate Filed District Number Register Number City,XXXI COMP Schenectady 4601 334 :: ❑Burial Date Cemetery or Crematory ❑Entombment 03/31/2017 Pine View Crematory Address <v❑Cremation Queensbury, Ny Date Place Removed Z Removal and/or Held 2❑and/or Address i= Hold tI) O Date Point of Transportation Shipment 0 by Common Destination Carrier • El Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral HomeBaker Funeral Home 01130 Address 11 Lafayette St, Queensbury, Ny 12804 Name of Funeral Firm Making Disposition or to Whom 11- Remains are Shipped, If Other than Above 2 Address Cr lit Permission is hereby granted to dispose of the human remai ���[described bove s indicated. Date Issued 03/30/2017 Registrar of Vital Statistics ©�y`""�� kr (signature) District Numbe4601 Place Schenectady I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: III Date of Disposition ifion Place of Disposition . . & �J1 e `rimrtoela-1 2 (address) IW ir (section) (lot number) ((-,� (grave number) CI Name of Sexton or Person in Charge f Premises t(Xr.c't� r JHt41It 2 (pl se print) Signature l ,41 Title ( I rMiL (over) DOH-1555 (02/2004)