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Baker, John NEW YORK STATE DEPARTMENT OF HEALTH I g Vital Records Section Burial - Transit Permit Name First Middle Last Sex John Walter Baker Male '!: Date of Death Age ' If Veteran of U.S. Armed Forces, March 9, 2015 74 yrs. War or Dates 1958-1964 ii.4 Place of Death Town of Hospital, Institution or City, Town or Village Hague j Street Address 18 Overlook Lane ill © Manner of Death UNatural Cause n Accident 0 Homicide [1 Suicide Undetermined u Pending W —Circumstances Investigation 18, Medical Certifier Nam itle ;) DP /A P �frlicA b /I Address i r // e.eoss S-1-, boiton t ttirii A)-y. / g/�f '> Death Certificate Filed Town of District Number Register Number City, Town or Village Hague 5653 ' Date 1 Cemetery or Crematory n Burial March 1 1 , 2015 Pine View Crematory Address fA Cremation Queensbury, New York Date Place Removed C Removal and/or Held and/or Hold Address �- 0 0 Date Point of N ❑Transportation Shipment a by Common Destination Carrier Disinterment 1 Date ' Cemetery Address Reinterment Date Cemetery Address iiai Permit Issued to Registration Number Name of Funeral Home Wilcox & Regan funeral home 01 821 Address 11 Algonkin St. , Ticonderoga, NY 12883 ie Name of Funeral Firm Making Disposition or to Whom oRemains are Shipped, If Other than Above 01 Address LU a aV Permission is hereby granted to dispose of the human remains described above as indicated. I mii ipi Date Issued 3/11 /2015 Registrar of Vital Statistics r- C 0...1,k, C._ on,,, , ,, I'signa ire JC 81 District Number 5653 Place Town of Hague I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: f- , Date of Disposition 3I ',jir Place of Disposition ;e21'r C Idev-i W (address) CC (section) / (lot number) (grave number) GName of Sexton or Person in Charge of Premises Gi‘#K}.;_. 324041i i_ (please print) Po! Signature Title fiZ Ci.s41, l yli, (over) DOH-1555 (9/98)