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Hitchcock, Fred 4 sfti NEW YORK STATE DEPARTMENT OF HEALTI`1 _ . .* (i Vital Records Section Burial - Transit Permit Name First Middle Last Sex Fred Wilb Hitchcock Male Date of Death Age N eteran of U.S. Armed Forces, November 7,2017 68 War or Dates Vietnam Place of Death Hospital, Institution or City, Town or Village Johnsburg Street Address Manner of Death X Natural Cause Accident I I Homicide Suicide Undetermined Pending Circumstances Investigation a Medical Certifier Name Title 0: Paul Bachman Address 3767 Main Street,HHHN,Warrensburg,NY 12885 Death Certificate Filed District Number Register Number City, Town or Village Johnsburg 5655 31 ❑Burial Date Cemetery or Crematory Entombment Address 9,2017 Pine View Crematory Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed Z I I Removal and/or Held and/or Address H Hold O Date Point of NTransportation Shipment 'p by Common Destination Carrier Disinterment Date Cemetery Address Renterment Date Cemetery Address Permit Issued to Registration Number . Name of Funeral Home Alexander-Baker Funeral Home 00037 Address £°; 3809 Main Street,Warrensburg,NY 12885 _ 1 Name of Funeral Firm Making Disposition or to Whom : ] Remains are Shipped, If Other than Above Address I Permission is hereby granted to dispose of the human r ains describe above a in 'cated. Date Issued 1 1— 8- (1), Registrar of Vital Statistics (signat District Number 5655 Place Johnsburg I certify that the remains of the decedent identified above were disposed of inaccordance with this permit on: wDate of Disposition ll / co g7 Place of Disposition i,, U..' 4cx...— W (address) CO O (section) j� (lot number (grave number) p• Name of Sexton or Person in Charge of Premises `AA, L $M,1ir Z (Tease print) iu Signature 6( , Title fk'lEvrn.v.- (over) DOH-1555 (02/2004)