Redican, Francis Sl�
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Francis W. Redican Male
Date of Death Age If Veteran of U.S. Armed Forces,
July 20,2016 81 War or Dates
Place of Death Hospital, Institution or
Z' City, Town or Village Bolton Street Address 101 Rainbow Beach Road
p Manner of Death X Natural Cause I Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W, Medical Certifier Name Title
C• John W.Kirk,MD
Address
Death Certificate Filed I District Number Register Number
City, Town or Village Bolton 5650 5
❑Burial Date Cemetery or Crematory
El
July 21,2016 Pine View Crematory Entombment
Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
Hold
O Date Point of
Transportation 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 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
F- Remains are Shipped, If Other than Above
2 Address
• Permission is hereby granted to dispose of the human remains de cribe above as indicated.
Date Issued -7--2/-.2O I Cd Registrar of Vital Statistics above
(signature)
District Number 5 G(50 Place )Oi; )C Ti ?)c I -/-'o t'
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
/ O (mot
W Date of Disposition 7 � lL Place of Disposition ,� �.� c••-..
W (address)
CO
(section) ir (lot number)— (grave number)
pName of Sexton or Person in Charge of Premises ,31-1)1+.'- Jl%
Z � � (please print)
W Signature Title CRC'-Tf Vt
(over)
DOH-1555 (02/2004)