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Needham, Reginald NEW YORK STATE DEPARTMENT OF HEALTH �1 Vital Records Section A Burial - Transit Permit .. , Name First Middle Last Sex Reginald J. Needham Male :. Date of Death Age If Veteran of U.S. Armed Forces, a July 2, 2014 83 War or Dates .°_° Place of Death Hospital, Institution or h City, Town or Village Warrensburg Street Address 5 Fourth Avenue Gin Manner of Death X Natural Cause n Accident n Homicide Suicide Undetermined Pending 111, Circumstances Investigation u° Medical Certifier Name Title Paul Bachman MD __:: Address o-° 3767 Main Street,HHHN,Warrensburg,NY 12885 • Death Certificate Filed District Number Register Number City, Town or Village Warrensburg 5660 /0 ❑Burial Date Cemetery or Crematory ❑Entombment July 3, 2014 Pine View Crematory Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed Z Removal and/or Held O - and/or Address t Hold Cl) O Date Point of Nn Transportation Shipment a by Common Destination Carrier Disinterment Date Cemetery Address pi Reinterment Date Cemetery Address :' Permit Issued to Registration Number s =" Name of Funeral Home Alexander-Baker Funeral Home 00037 Address ',ire 3809 Main Street,Warrensburg,NY 12885 o.o Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above • Address U3 Permission is hereby granted to dispose of the human rem 'ns de cribed above a 'ndicat . _4_____. s o• Date Issued IPA q Registrar of Vital Statistics ad !! (sign ture) m gs District Number 5660 Place Warrensburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z tu .r Date of Disposition 1/3114 Place of Disposition ik^-1 CW4P(.W (address) U) CC p0 (section) (lot number (grave number) Name of Sexton or Person in Charge of Premises ti ,.dt Z ( ease rin,,t) W Signature 4L A Title ( .-(r►i1 (over) DOH-1555 (02/2004)