Baker, Donald NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Donald E. Baker Male
Date of Death Age If Veteran of U.S. Armed Forces,
September 30,2016 74 War or Dates Vietnam
t.': Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death I XI Natural Cause Accident Homicide Suicide Undetermined Pending
la Circumstances Investigation
W° Medical Certifier Name Title
IA Kamal
-? Address
�_] ,Glens Falls,NY 12801
: . Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 , )3
❑Burial Date Cemetery or Crematory
❑Entombment October 3,2016 Pine View Crematory
Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
Cl)
O Date Point of
COTransportation 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 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
RI Address
tK
Au
Or, Permission is hereby granted to dispose of the human remains described above as indicated.
_Date Issued 10` 3//6 Registrar of Vital Statistics LrUC J ' „ LA��-f
(signa ure)
District Number (-)so I Place �^,-.5 /�}�,)
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 16I ilill Place of Disposition ent04i-✓ Ctin lcvlOfk6"/
2 (address)
W
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CL (section) l (lot number) (grave number)
Q Charge Name of Sexton or Person in f Premises I4r.S to/ S I-
'Z A (plse print) iii/(
ui Signature ✓�
9 a? Title C t3F-h'►►Rl�t.
(over)
DOH-1555 (02/2004)