Tucker, Gordon I
NEW YORK STATE DEPARTMENT OF HEALTH # z
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Gordon E. Tucker Male
Date of Death Age If Veteran of U.S. Armed Forces,
April 30,2014 73 War or Dates 1958- 1964
Place of Death Hospital, Institution or
Z City, Town or Village Chester Street Address 23 Mountain Estates Road
p, Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Itt Circumstances Investigation
to Medical Certifier Name Title
0, Daniel Way
Address
HHHN,North Creek,NY 12853
Death Certificate Filed District Number Register Number
City, Town or Village Chester 5652 11
❑Burial Date Cemetery or Crematory
May 1,2014 Pine View Crematory
Entombrnent Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
O Date Point of
u) 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
Remains are Shipped, If Other than Above
'X, Address
Permission is hereby granted to dispose of the human r m •ns,de crib. . - i •ve indicated.
Date Issued S/PSI/AO/y' Registrar of Vital Statistics i
` (signature)
District Number 5652 Place Chester
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 5 JJ pi Place of Disposition &nf L1 Co-c4n.
W (address)
N
(section) ` (lot number) (grave number)
pName of Sexton or Person in Char a of Premises 71,,,fri,_ 3,4,44
Z (please print)
W
Signature c� Title Ci k PAZlZ
(over)
DOH-1555 (02/2004)