Armstrong, Sr. Gregory s 4 3s3
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Gregory L. Armstrong,Sr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
July 11,2011 56 War or Dates
.. Place of Death Hospital, Institution or
'Z City, Town or Village Schroon Street Address 300 Severance Road
p Manner of Death l)[(Natural Cause Accident Homicide ( I Suicide Undetermined Pending
tit II`"' Circumstances Investigation
iii G Medical Certifier Name Title
Joseph Schwerman
Address
HHI-IN,Schroon Lake,NY 12870
Death Certificate i ed District Number/ � I Register 9Jumber
City, Town or Village Schroon Lake !
❑Burial Date Cemetery or Crematory
El Entombment July 13,2011 Pine View Crematory
Address
❑X Cremation Quaker Rd.,Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
O and/or ; Address
Hold
O Date Point of
wTransportation 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
2 Address
tY
w AM
a
Permission is he by ranted to dispose of the human r s describe erove as indicated.
Date Issued r/3 /� Registrar of Vital Statistics ,'_ / - y IA _,. ,
(signature)
District Number 457,3 Place Schroon Lake
H
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
tu Date of Disposition ' lc-I t Place of Disposition fntt) j Cc q to ak-
(address)
Ili
U)
Ce (section) (lot nupzber) (grave number)
pName of Sexton or P son in Char a of Premises r,3 N.fL
Z „ (please punt)
W g 1 Cie L
Si nature Title NI VTOL
(over)
DOH-1555 (02/2004)