Baker, Christopher NEW YORK STATE DEPARTMENT OF HEALTH4. /
Vital Records Section
�` Burial - Transit Permit
. A
Name First Middle Last Sex
Christopher James Baker Male
Date of Death Age If Veteran of U.S. Armed Forces,
April 9, 2016 18 War or Dates
Place f Death g Hospital,r I titution or 90 A)6\ QC&Me S. -
�, Village Fort Edward Street Address
Manner of Death❑ Natural Cause ❑ Accident ❑ Homicide ❑ Suicide 1-1 Undetermined ❑ Pending
Circumstances Investigation
Ill Medical Certifier Name Title
0 Robert Lemieux,
Address
219 Pope Hill Road Argyle, NY 12809
Death Certificate Filed District Numb. A Regist Number
City, Town or Village Fort Edward .
❑Burial Date Cemetery or Crematory
April 14, 2016 Pine View Crematory
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
o and/or Address
E Hold
0 Date Point of
a ❑Transportation Shipment
by Common Destination
0 Carrier
Date Cemetery Address
III Disinterment
Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home- FE 01079
Address
82 Broadway, Fort Edward NY 12828
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above i
Address
1
W
# . Permission is hereby granted to dispose of the human e • described bgv�e as ' d' ated.
Date Issued /� oD(V Registrar of Vital Statistics V
865 )t'.fl.LY7t 1i d(-1-4/0nature)
District Number Place
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 04/14/2016 Place of Disposition Quaker Road Queensbury,NY 12804
2 (address)
(section) (lot number) (grave number)
Q Name of Sexton or Person in Charge of Premises Att, 50t41"1
(( / lease print)
141 Signature ,,dr Title i#41-0/1
(over)
DOH-1555 (02/2004)