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NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last I Sex
David N. Alger 1 Male
Date of Death Age If Veteran of U.S. Armed Forces,
January 10,2014 47 War or Dates Desert Storm
F- Place of Death Hospital, Institution or
,Z City, Town or Village Thurman Street Address 389 Bowen Hill Rd.
pManner of Death Natural Cause Accident Homicide X Suicide Undetermined Pending
v Circumstances Investigation
W Medical Certifier Name Title
0 1 Timothy E.Murj by Mr
Address
52 Haveland Ave.,Glens Falls,NY 12801
Death Certificate Filed District Number ' Register Number
City, Town or Village Thurman 5659 2
❑Burial Date ' Cemetery or Crematory
ID Entombment January 13,2014 , Pine View Crematory
Address
❑x Cremation 21 Quaker Rd., Queensbury,NY 12804
Date ' Place Removed
Z Removal and/or Held
O and/or ^` Address
Hold
O Date ' Point of
co n Transportation Shipment
0 by Common Destination
Carrier
]Disinterment Date Cemetery Address
1 i Reintermet Date Cemetery Address
_
Permit lss to Registration Number
Name of F` al Home Alexander-Baker Funeral Home 00037
Addres - '° -
3809 11 in Street,Warrensburg,NY 12885
Name 6f Funeral Firm Making Disposition or to Whom
F- Remains are Shipped, If Other than Above
2 Address
W
G.
Permission is he eby granted to dispose of the human r ins scribed ov i dic d.
Date Issued Df / Registrar of Vital Statistics
(signature)
District Number 2W 7 Place /own � ` ) [u r ozon
I certify that the remains of the decedent identified above were disposed of in``accordance with this permit on:
LU Date of Disposition /N J(f Place of Disposition gilt U ( 04-.
(address)
W
CL (section) (lot mber) (grave number)
0 Name of Sexton or Person in Charge of Premises f rnfi i ..X healer
Z (pie�se print)
Title C12 14L
Signature i y M G Q
(over)
DOH-1555 (02/2004)