Carmen, Duane NEW YORK STATE DEPARTMENT OF HEALTH , - . �i
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Duane S. Carmen Male
Date of Death Age If Veteran of U.S. Armed Forces,
June 13,2015 58 War or Dates
,,,: Place of Death Hospital, Institution or
Z City, Town or Village Warrensburg Street Address 96 Rocky Ridge Rd.
aManner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
l Medical Certifier Name Title
0 Paul Bachman
Address
HHIfIN,Warrensburg,NY 12885
Death Certificate Filed District Number ��� Register Number
City, Town or Village
❑Burial Date Cemetery or Crematory
June 16,2015 Pine View Crematory
Entombment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z I J Removal and/or Held
and/or Address
Hold
U)
O Date Point of
NI I Transportation Shipment
p 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
i- Remains are Shipped, If Other than Above
Address
Permission is hereby ranted to dispose of the human r mains d ri d above as indicated.
Date Issued / / Registrar of Vital Statist
,� f ivy
� 1 (signature)
District Number 57 4,/) Place 771 r-L 1 ib!'u , ✓ v y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
wDate
(p of Disposition (if!(— Place of Disposition ,�L,,,
W (address)
CO
(section) lot numb!, (grave number)
pName of Sexton or Person in Ch rge of Premises
�%lease
Z print)
W Signature Title
(over)
DOH-1555 (02/2004)