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Combs, Cy If NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Cy R. Combs Male Date of Death Age If Veteran of U.S. Armed Forces, November 28,2016 29 War or Dates Place of Death Hospital, Institution or Z City, Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death I Xi Natural Cause Accident pi Homicide Suicide Undetermined Pending W. Circumstances Investigation W, Medical Certifier Name Title GI Kamban Dr. Address Physicians Oncology A139,Albany Med. Center,Albany,NY Death Certificate Filed District Number D6)0 J Register Number City, Town or Village 1J ❑Burial Date Cemetery or Crematory November 30,2016 Pine View Crematory 0 Entombment Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed Z l I Removal and/or Held and/or Address �' Hold v) O Date Point of O. l 'Transportation Shipment 'p by Common Destination Carrier Disinterment Date Cemetery Address 1-7 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 I- Remains are Shipped, If Other than Above X Address Ul eft, d Permission is hereby granted to dispose of the human emains d scribe above as ' dic ed. Date Issued (/'. c,f t)lip Registrar of Vital Statistics '� (signature) ----e— --& District Number r'�jam , Place . ' 41, G I certify that the remains of the decedent identified above were disposed of in accordan with this permit on: W Date of Disposition ill I 1 t6 Place of Dispositionn:di� t'" ►, ;)r,,. W (address) U) rL (section) /1 (lot numb(�) (grave number) p Name of Sexton or Person in Charge of Premises 16r,, or. JeHA4Tt `Z please print) Signature zit J, Title CRel1Mi (over) DOH-1555 (02/2004)