Remington, Roger 13
NEW YORK STATE DEPARTMENT Oi. h . TH ' _ 1
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Roger W. Remington Male
Date of Death Age If Veteran of U.S. Armed Forces,
February 18,2011 70 War or Dates Vietnam
Place of Death Hospital, Institution or
, City, Town or Village Glens Falls Street Address Glens Falls Hospital
g, Manner of Death X Natural Cause Accident I I Homicide Suicide Undetermined Pending
,{; Circumstances Investigation
u Medical Certifier Name Title
T. Slingerland
Address
Glens Falls Hospital,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 S 6
❑Burial Date Cemetery or Crematory
February 23,2011 Pine View Crematory
❑Entombment Address
®Cremation Quaker Rd.,Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
• and/or Address
H Hold
N
O Date Point of
N 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
i. Remains are Shipped, If Other than Above
e
Address
`1 Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 2J2 2./i I Registrar of Vital Statistics Lam, -\J - Et
(sign ure)
: District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Lu Date of Disposition L-.2 to-tl Place of Disposition Pm�ct.,l *�it°rw►�
(address)
W
Cl)
IX (section) n (topaz. ber) (grave number)
Q Name of Sexton or Person in Ch rge of Premises L h�.�
ZA ` (please print)
La
Signature Title CI rog
(over)
DOH-1555 (02/2004)