Planty, Floyd }
# 253
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Floyd J. Planty Male
Date of Death Age If Veteran of U.S. Armed Forces,
April 15,2014 80 War or Dates
.. Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls ; Street Address Glens Falls Hospital
Manner of Death X Natural Cause I I Accident I I Homicide I Suicide Undetermined Pending
Circumstances Investigation
V
W Medical Certifier Name Title
Ct Eric Pillemer
Address
CR Wood Cancer Center,Glens Falls,NY 12801
Death Certificate Filed ! District Number Register Number
City, Town or Village Glens Falls 5601 j 8'9
❑Burial Date Cemetery or Crematory
El Entombment April 16,2014 Pine View Crematory
Address
1x Cremation 21 Quaker Rd.,Queensbury,NY 12804
Date ! Place Removed
Z Removal and/or Held
and/or Address
Hold
0 Date Point of
NTransportation Shipment
p by Common Destination
Carrier
Disinterment Date I 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
E Address
_
a
Permission is hereby granted to dispose of the human remains described� above as,indica�teed.
Date Issued `-'l/ 7 6) ' Registrar of Vital Statistics LA-)cA- 4 ,� }3•J-' -4 1/CQd
(signature) UU
District Number 5601 Place Glens Falls) iv
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z a �+
tu Date of Disposition y 111 try Place of Disposition ff`n u,s C,t•widfr‘o--
(address)
co
(section) (lot`ember) (grave number)
pName of Sexton or Person in Charge of Premises pl_ mitr-
W ` (please print)
Signature Title C( w>rh
(over)
DOH-1555 (02/2004)