Hall, David NEW YORK STATE DEPARTMENT OF HEALTH S.
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Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
David D. Hall Male
Date of Death Age If Veteran of U.S. Armed Forces,
September 22,2012 58 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death I X)Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
w Medical Certifier Name Title
a Daniel Way
Address
HHHN,Warrensburg,NY 12885
Death Certificate Filed District Number Regi to Nmber
City, Town or Village Glens Falls 5601
❑Burial Date Cemetery or Crematory
September 25,2012 Pine View Crematory
0 Entombment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
H Hold
O Date 1 Point of
O.
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 00035
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
Ix
W.
"; Permission is hereby ranted to dispose of the huma(emain described tipove as indi ated.
Date Issued n Registrar of Vital Statistics QZ ...1,—) 4l`c,
(sire)
District Number 5601 Place Glens Falls ,
I certify that the remains of the decedent identified above wer disposed of in accordance with this permit on:
w Date of Disposition cj /2s/it Place of Disposition r,,,41.L„) Cre%-c;t;r.a"-
w (address)
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co
re (section) (lot number) — (grave number)
Q Name of Sexton or Perso in Charge of Premises dr.s �nrc(♦-
Z ( lease print)
w Signature L Title C tt f MA .
(over)
DOH-1555 (02/2004)