Hensler, Charles 2NEW YORK STATE DEPARTMENT OF HEALTH 5.5-2..
Vital Records Section tit Burial - Transit Permit
' Name First Middle Last Sex
Charles H. Hensler Male
Date of Death Age `,, . If Veteran of U.S. Armed Forces,
August 7,2015 78 .0, War or Dates
Place of Death Hospital, Institution or
City, Town or Village Bolton Street Address 1819 East Schroon Myer Road
p Manner of Death Undetermined Pending
Natural Cause Accident Homicide Suicide
ttt Circumstances Investigation
a Medical Certifier Name Title
Aqeel Gillani MD
Address
- - CR Wood Cancer Center, 102 Park St.,Glens Falls,NY 12801
Death Certificate Filed District Number Register umber
City, Town or Village T/O Bolton 5650 ,.
❑Burial Date Cemetery or Crematory
El
Entombment August 12,2015 Pine View Crematory
Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
F' Hold
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O Date Point of
% 1 I Transportation Shipment
a 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
F Address
Permission is hereby granted to dispose of the human remain described a• ,Iv- as indic ted.
Date Issued D '((/L f. Registrar of Vital Statistics ( a, / '/,t azx k
` 6Pl47L' `Eg.,%3 1.lf ature)
District Number 5650 Place T/O Bolton,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition g113115. Place of Disposition -PmOj,./ C,... t....
W (address)
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0 (section) A _ (lot number) (grave number)
Op Name of Sexton or Person in Charge of Premises t/ ( Sea,,-y
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W Signature 4L Title !?t444 4
(over)
DOH-1555 (02/2004)