Stone, Raymond NEW YORK STATE DEPARTMENT OF HEALTH N # ZZ tr
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Raymond Arthur Stone Male
Date of Death Age If Veteran of U.S. Armed Forces,
April 30,2011 86 War or Dates World War II
1,.,. Place of Death Hospital, Institution or
Z City, Town or Village Warrensburg Street Address 19 Marion Ave.
{p Manner of Death Natural Cause I Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
C Dr.James Hicks,MD
Address
{ HHHN,North Creek,NY 12853
Death Certificate Filed District Number Register Number f
City, Town or Village Warrensburg 5660 (0
❑Burial Date Cemetery or Crematory
Entombment May 2,2011 Pine View Crematory
Address
Ex Cremation Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
O and/or Address
N Hold
N
0 Date Point of
NTransportation 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 00035
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
2, Address
tt
Permission is hereby granted to dispose of the human re • d scri above as i i dicated.
Date Issued yo2-/// Registrar of Vital Statistics GLn( -� � ', ,
(sigrl'atu -
District Number 5660 Place Warrensburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
w Date of Disposition Cis/ii Place of Disposition - �LI,N.. C r9, rv+tic f o goy._
W (address)
co
Et (section) i (lot numb¢e►1 (grave number)
pName of Sexton or Person in Charge f Premises di:sile,f- 0Elvir.lt
Z (please print)
w Signature Title (0 e ithlit(L,
(over)
DOH-1555 (02/2004)