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Degelormo, Thomas NEW YORK STATE DEPARTMENT OF HEALTH , ' . T O'J Vital Records Section Burial - Transit Permit Name First Middle Last Sex Thomas Oliver Degelormo Male Date of Death Age If Veteran of U.S. Armed Forces, February 3,2016 63 War or Dates 1'= Place of Death Hospital, Institution or City, Town or Village Warrensburg Street Address 4112 State Route 9 Manner of Death I XI Natural Cause Accident I I Homicide Suicide Undetermined Pending Circumstances Investigation It Medical Certifier Name Title : Timothy E.Murphy Warren Co. Coroner Address 52 Haviland Ave.,Glens Falls,NY 12801 Death Certificate Filed District Number Register Number City, Town or Village T/O Warrensburg 5660 ❑Burial Date Cemetery or Crematory February 5,2016 Pine Vie* Crematory II Entombment Address ©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 u) 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 'I Address 3809 Main Street,Warrensburg,NY 12885 Name of Funeral Firm Making Disposition or to Whom -lea Remains are Shipped, If Other than Above Address 1 Permission is he eby granted to dispose of the human re describ d above as indicated. Date Issued 4 / Registrar of Vital Statistics . 6.436 (signature) District Number 5660 Place T/O Warrensburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z w Date of Disposition 2,.—s-- 16 Place of Disposition P►ne. V.:f.,W CR,Aida W (address) N re (section) (lot number) (grave number) pName of Sexton or Person in Charge of Premises -Rim 0( Cjj 1ci5 Z (please print) W Signature / ,. / Title C.Ii.►r►:r}or // (over) DOH-1555 (02/2004)