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Mandinec, John 1. .. v 048 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex John S. Mandinec Male Date of Death Age If Veteran of U.S. Armed Forces, . December 11,2016 70 War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital 0 Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending 1t Circumstances Investigation us Medical Certifier Name Title a Address Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 1 2. ❑Burial Date Cemetery or Crematory December 13,2016 Pine View Crematory El Entombment Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed ZZ I I Removal and/or Held and/or Address H Hold CO 0 Date Point of NI 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 00037 Address :-, 3809 Main Street,Warrensburg, NY 12885 wt� Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address id 11.4 Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12- ( 13 /f, Registrar of Vital Statistics `' (signs re) 3 District Number 5 6 Q I Place 4 S �/1 `1 S J 0,) 7 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z w Date of Disposition 12)MI6 Place of Disposition e� a cr[me ofty_ W (address) co rt (section) /,,/ (lot number) r (grave number) pName of Sexton or Person in Charge of Premi es G Aro1 r- je.111 d' Z ( lease print) W Signature � Title CAE/ l (over) DOH-1555 (02/2004)