Kenna Jr, Edward 4 i # 5S 1
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Edward F. Kenna,Jr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
August 13,2016 72 War or Dates Vietnam
Place of Death Hospital, Institution or
Z; City, Town or Village Glens Falls Street Address Glens Falls Hospital
ILI
Manner of Death I Xi Natural Cause I j Accident [ I Homicide r Suicide Undetermined Pending
IliCircumstances Investigation
L; Medical Certifier Name Title
Cl Joseph C.Mihindu
Address
20 Murray Street,Glens Falls,NY 12801
Death Certificate Filed District Number LL //,�,� Register Number
City, Town or Village J('t) 1 1.1 t S
❑Burial Date Cemetery or Crematory
❑Entombment August 15,2016 Pine View Crematory
Address
11 Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z - Removal and/or Held
and/or Address
H Hold
co
0 Date Point of
551 I Transportation Shipment
a 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
Remains are Shipped, If Other than Above
E Address
ttit
Permission is hereby granted to dispose of the human remains described above as indicate .
Date Issued ? 1 /6116 Registrar of Vital Statistics
/ M r (signature)
District Number 560 r Place 6 ISC s �t )s f n1
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
Date of Disposition gr11//6 Place of Disposition taU,V(/
W (address)
U)
fY
p
(section) //-(lot number)`C (grave number)
Name of Sexton or Person in Charge of Premises L�
Z '7 (p ase print)
W
Signature 4
Title (tit
(over)
DOH-1555 (02/2004)