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Thorpe, John NEW YORK STATE DEPARTMENT OF HEALTH tigl Vital Records Section Burial - Transit Permit Name First Middle Last Sex John A. Thorpe Male . Date of Death Age If Veteran of U.S. Armed Forces, October 27,2015 82 War or Dates Korean Place of Death Hospital, Institution or City, Town or Village Stony Creek Street Address 64 Harrisburg Road 01 Manner of Death Natural Cause Accident 1 1 Homicide X Suicide Undetermined Pending Circumstances Investigation u', Medical Certifier Name Title 1:1 Gary Scidmore a Address 6930 State Rt.8,Brant Lake,NY 12815 f 3 Death Certificate Filed District Number r Register Number C q' City, Town or Village T/O Stony Creek 5658 ❑Burial Date Cemetery or Crematory October 30,2015 Pine View Crematory El Entombment Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed Z Removal and/or Held and/or Address H Hold u) - O Date Point of coTransportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address 3°3 Permit Issued to Registration Number j Name of Funeral Home Alexander-Baker Funeral Home 00037 333 Address 3809 Main Street,Warrensburg,NY 12885 _ Name of Funeral Firm Making Disposition or to Whom I.- Remains are Shipped, If Other than Above 1 Address ILI Permission is hereby granted to dispose of the human re ains described a as i d. Date Issued 10/29/2015 Registrar of Vital Statistics Syr,I _ pd. (signature) District Number 5658 Place T/O Stony Creek,NY I certify that the remains of the decedent identified above were disposed of inaccordance with this permit on: W Date of Disposition p 13°Iic Place of Disposition µL, r ciar�.. W (address) U) ce (section) /(lot number) (grave number) pName of Sexton or Person in Charge of Premises (/Irr, 5���- Z (pl ase print) Wd 4.Signature Title 011- (over) DOH-1555 (02/2004)