Massinger, Heinrich pr yob
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
°® Name First Middle Last Sex
° Heinrich Massinger Male
;: g
Date of Death - Age If Veteran of U.S. Armed Forces,
a July 13,2014 86 War or Dates
ZPlace of Death Hospital, Institutioirondack Trii-County Health Care
rt City, Town or Village Johnsburg Street Address Center
�G° Manner of Death X Natural Cause n Accident Homicide n Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
e James Hindson Dr.
a : Address
.: Main St.,Warrensburg,NY 12885
a' Death Certificate Filed District Number Register Number
R ` City, Town or Village Johnsburg 5655 I I
❑Burial Date Cemetery or Crematory
El Entombment July 16,2014 Pine View Crematory
Address
❑X Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
Hold
co
0 Date Point of
coTransportation Shipment
a by Common Destination
Carrier
Li Disinterment Date Cemetery Address
•
Reinterment Date Cemetery Address
of Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
=x'u; 3809 Main Street,Warrensburg, NY 12885
°_; Name of Funeral Firm Making Disposition or to Whom
i.j: Remains are Shipped, If Other than Above
{ Address
Permission is ereb granted to dispose of the human r "[is described bove as indicated.
.: Date Issued r tut 14 Registrar of Vital Statistics Lr n Q-
(signature)
;' District Number 5655 Place Johnsburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
ui Date of Disposition ~1-6- (H Place of Disposition Riti,.,,..t C,.... ,,f -
W (address)
CO
CL (section) (lot number) r (grave number)
pName of Sexton or Person in arge of P emises Aittt., „+•oj�
Z (ph ase print)
Signature Title (}LffRgil
(over)
DOH-1555 (02/2004)