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Guilder, Edward i NEW YORK STATE DEPARTMENT OF HEALTH - Transit Permit Vital Records Section _r1:a_ Burial Name First Middle Last Sex Edward J. Guilder Male is Date of Death Age If Veteran of U.S. Armed Forces, 08/02/2011 68 years War or Dates :- Place of Death Hospital, Institution or City, T itr l/jEl0 Amsterdam Street Address 15.Wi son Avenue Ittci Manner of Death©Natural Cause Accident Homicide Suicide Undetermined �Pending (Li Circumstances Investigation iii Medical Certifier Name Title O Robert Gosiin Md Address 1700 Riverfront Center Death Certificate Filed District Number Register Number <' City, TryAin Amsterdam 2801 199 []Burial Date 4 Cemetery or Crematory ❑Entombment 08108/2011 Pineview Crematorium Address ®Cremation Queensbury. New York Date Place Removed 2 or: ` H01d ❑Removal and/or Held and/or Address to • Date Point of • Transportation Shipment ci by Common Destination giii Carrier 0 Disinterment Date - Cemetery Address Q Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home 00448 << Address 7 Sherman Avenue, Cornith, NV Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above • Address IL gIL` Permission is hereby granted to dispose of the human reins described o ie as indi d. Date Issued 08/03/2011 Registrar of Vital Statistics ) �,N, 0 iim (signature) iiiiiii District Number 2801 Place Amsterdam I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 2 /� tit Date of Disposition i ---t 1 Place of Disposition Piot V i w C_r f o (address) ill LC (section) (lot number) (grave number) O a ,ci Name of Sexton or Per n in Charge Premises dif C n 2 (lease print) • Signature Title Cii w'rTlt (over) DOH-1555 (02/2004)