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Heid, Peter c i _ 1, Z.- NEW YORK STATE DEPARTMENT OF HEALTH p Vital Records Section pn,,,;;;.,.:. <7urial - Transit ermlt Name First Middle Last Sex Peter G. Held Male . Date of Death Age If Veteran of U.S. Armed Forces, September 1,2016 53 War or Dates lu:' Place of Death Hospital, Institution or Z City, Town or Village Johnsburg Street Address 69 Thissell Rd. la Manner of Death X Natural Cause I I Accident [-Homicide Suicide Undetermined ,Pending Al Circumstances Investigation t Medical Certifier Name Title N. Balasubramaniam Address 50 Braod St.,Waterford,NY 12188 Death Certificate Filed District Number r- �; Register Number City, Town or Village ��,- f'7 ❑Burial Date Cemetery or Crematory (( ❑Entombment September 6,2016 Pine View Crematory Address Ei Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed ZZ L I Removal and/or Held and/or Address F_- Hold to a Date Point of N Transportation Shipment a by Common Destination Carrier — Disinterment Date Cemetery Address ri 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 2 Address CL Permission is hereby granted to dispose of the human r ins describe above as indicated. Date Issued- 4` 16 Registrar of Vital Statistics bCk_ tr atu District Number 5 Place` ©u.sl,t� c cALP• I certify that the remains of the decedent identified above were disposed of in accordanc ith this permit on: Z w Date of Disposition ling Place of Disposition 41,-.- ar W (address) U) p0 (section) f (lot number) (grave number) Name of Sexton or Person in Charge of Premises 4 �„ e.w Z lease print) LLI di Signature 'l ,, --- Title Gf }/-- (over) DOH-1555 (02/2004)