Warrington, Charles NEW YORK STATE DEPARTMENT OF HEALTH ,
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Charles D. Warrington Male
Date of Death Age If Veteran of U.S. Armed Forces,
March 7,2015 56 War or Dates
F° Place of Death Hospital, Institution or
Z City, Town or Village Johnsburg Street Address State Route 8
Manner of Death X Natural Cause Accident n Homicide Suicide Undetermined Pending
Circumstances Investigation
w Medical Certifier Name Title
Gary Scidmore
Address
6930 State Rt.8,Brant Lake,NY 12815
Death Certificate Filed District Number Register Number
City, Town or Village Johnsburg 5655
ā¯‘Burial Date Cemetery or Crematory
Entombment March 9,2015 Pine View Crematory
Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal , and/or Held
and/or Address
H Hold
N
0 Date Point of
N I f Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
U Renterment 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
Address
Permission is hereby granted to dispose of the human r ins described a ove as 'ndicated.
Date Issued 3- _ 1 s' Registrar of Vital Statistics
(signature)
District Number 5655 Place Johnsburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition Vilig Place of Disposition
(address)
Cl)
(section) it (lot number) (grave number)
QName of Sexton or Person in Charge of Premises 4444., a
lease print)
W Signatures Title tri.4"-hiL
(over)
DOH-1555 (02/2004)