Blair, Peter NEW YORK STATE DEPARTMENT OF HEALTH ~+ r"'
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Peter David Blair Male
Date of Death Age If Veteran of U.S. Armed Forces,
August 5,2015 76 War or Dates
i
Place of Death Hospital, Institutior1dirondack Tri-County Health Care
City, Town or Village Johnsburg i Street Address Center
. Undetermined Pending
� Manner of Death X Natural Cause Accident Homicide Suicide
Circumstances Investigation
a Medical Certifier Name Title
James Hindson Dr.
Address
,`. Main St.,Warrensburg,NY 12885
Death Certificate Filed District Number Register Nu ber
t City, Town or Village T/O Johnsburg 5655 �-
❑Burial Date Cemetery or Crematory
ElEntombment August 6,2015 Pine View Crematory
Address
❑X Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
F' Hold
CO
O Date Point of
NTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
n Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
t Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
3 Remains are Shipped, If Other than Above
Address
L
11"` Permission is hereby granted to dispose of the human remains scribe.dl bo as indicat
Date Issued 08/06/2015 Registrar of Vital Statistics ' , Lc , _
(sigure
District Number 5655 Place T/O Johnsburg,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition q- 7- i5 Place of Disposition ne v,°ram C.r,r+-,e,Acyt^<'CJis,‘
W (address)
N
Ie (section) (lot number) (grave number)
i t w
Op Name of Sexton or P rson in C rge of Premises i bc- ,.-Sfe
'Z (please print)
Signature Title Crc vet'.,-7 4c 4.
(over)
DOH-1555 (02/2004)