Eddy, Loren ti i `153
NEW YORK STATE DEPARTMENT OF HEALTH `Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Loren D. Eddy Male
Date of Death Age If Veteran of U.S. Armed Forces,
July 3, 2015 86 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Thurman Street Address 232 Bear Pond Road
W Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
tu Medical Certifier Name Title
0 Love Dr.
Address
Iron Gate Practice,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number 6
City, Town or Village Thurman 5659
❑Burial Date Cemetery or Crematory
July 7,2015 Pine View Crematory
Ill Entombment'I Address
❑x Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
Cl)
O Date Point of
cn Transportation Shipment
6 by Common Destination
Carrier
Disinterment Date Cemetery Address
1
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
2 Address
f
tL1'.
4;
Permission is here,y granted to dispose of the human re ains described above s indicated.
J 4'
Date Issued • ._irw—Registrar of Vital Statistics ZAel- 614 I
(signatur
District Number 5659 Place T/O Thurman
H
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 1 I tits. Place of Disposition -1?44I ` {jv--
Ili
(address)
U)
IIY (section) (lot number) (grave number)
pName of Sexton or Person in Charge of Premises /4a r „52WO%
Z 1"---
(please print)
WSignature Title t7t-uyt11J�,
(over)
DOH-1555 (02/2004)