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Tanner, Edward NEW YORK STATE DEPARTMENT OF HEALTH • " Burial - Transit Permit Vital Records Section t 4 Name First Middle Last Sex Edward L. Tanner Male Date of Death Age If Veteran of U.S. Armed Forces, May 11,2015 69 War or Dates Place of Death Hospital, Institutiofirondack Tri-County Health Care .Z. City, Town or Village Johnsburg Street Address Center aManner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending U Circumstances Investigation u Medical Certifier Name Title CI James Hindson Dr. Address Main St.,Warrensburg,NY 12885 Death Certificate Filed District Number Register Number City, Town or Village T/O Johnsburg 5655 r&' E Burial Date Cemetery or Crematory May 12,2015 Pine View Crematory il Entombment Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed Z Removal and/or Held O and/or Address H Hold Cl) 0 Date Point of N1 I Transportation 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 I-. Remains are Shipped, If Other than Above Address CZ tii Permission is h reb granted to dispose of the human re ins described above as i - ated. Date Issued 5 as is Registrar of Vital Statistics l I ()a., (signs ur District Number 5655 Place T/O Johnsburg,NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z ' W Date of Disposition 5 /1391c' Place of Disposition ,ntU.,..i � .,,.- 2 (address) W CO 0 (section) (lot numb ) (grave number) p Name of Sexton or Person in Charge of Premises /4,4 Z f(please print) W Signature Title l 2Efi A'RV,: (over) DOH-1555 (02/2004)