Reynolds Jr, Rexford NEW YORK STATE DEPARTMENT OF HEALTH ' + '�
Vital Records Section Burial - Transit Permit
Name First Middle : Last Sex
Rexford C. Reynolds,Jr. Male
j Date of Death Age If Veteran of U.S. Armed Forces,
December 11,2015 85 War or Dates Korean
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
a Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
w Medical Certifier Name Title
Christopher D.Hoy
Address
102 Park Street,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village 5601 5 $g
❑Burial Date Cemetery or Crematory
December 14,2015 Pine View Crematory
0 Entombment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
H Hold
cn
0 Date Point of
N Transportation Shipment
p by Common Destination
Carrier
Disinterment Date 1 Cemetery Address
Li 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
1 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 remains described above as indicated.
Date Issued 12/ )4 I/5 Registrar of Vital Statistics 1
W liN) (signs re)
District Number 5601 Place ,' (s s rG 1 1 S, N y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
imDate of Disposition alma's ��,,Place of Disposition � : Crvowtor,v—.
2 (address)
LLJ
NCe _
(section) lot number) (grave number)
pName of Sexton or Person in Charge of remises f Ic j .Stnn
Z (p ase print)
uJ Signature4
Title azelt 1f}(0k
(over)
DOH-1555 (02/2004)