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Foos, Franklin NEW YORK STATE DEPARTMENT OF HEALTH ! Vital Records Section Burial - Transit Permit Name First Middle Last Sex Franklin J. Foos Male Date of Death Age If Veteran of U.S. Armed Forces, August 29,2011 67 War or Dates Vietnam 1., Place of Death Hospital, Institutionntt1irondack Tri-County Health Care Z City, Town or Village Johnsburg Street Address Center p' Manner of Death X Natural Cause Accident !Homicide , Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title 0 Thomas Warrington PA Address HHHN,Johnsburg,NY 12843 Death Certificate Filed District Number Register Number City, Town or Village Johnsburg 5655 3 / ❑Burial Date Cemetery or Crematory August 31,2011. Pine View Crematory Entombment Address ©Cremation Quaker Rd., Queensbury, NY 12804 Date Place Removed Z Removal and/or Held O and/or Address H Hold 0 Date Point of N I I 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 00035 Address 3809 Main Street, Warrensburg, NY 12885 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address tL Permission is(hereby granted to dispose of the human remai s describe b s indicated. Date Issued b I qv' (I Registrar of Vital Statistics . (signature) District Number 5655 Place Johnsburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z ' Date of Disposition 9 it lit Place of Disposition ç?,t,'tL. C4f 4 hJ.... (address) U) (section) (ot number) (grave number) Z Name of Sexton or Per n in Charge f Premises )(IN Sl please print) W Signature Title Ce0) Vt. (over) DOH-1555 (02/2004)