Dunkley, Kyle 4 1 6S
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Kyle A. Dunkley Male
Date of Death Age If Veteran of U.S. Armed Forces,
May 1,2014 34 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
0a Manner of Death Natural Cause Accident I I Homicide Suicide Undetermined x Pending
Circumstances Investigation
ui Medical Certifier Name Title
O Timothy E.Murphy Mr
Address
52 Haveland Ave.,Glens Falls,NY 12801
I Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 2. 1 5
❑Burial Date Cemetery or Crematory
May 2,2014 Pine View Crematory
Entombment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
Hold
Cl)
O Date Point of
N Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
n 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
a; Address
• Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued Jc-(2 ` I Registrar of Vital Statistics Ct/ti U
(signature)
District Number 5601 Place Glens Falls) N
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 5/ hti Place of Disposition 4 , C tar�.:
2 (address)
W
(section) r (lot numbr) (grave number)
p• Name of Sexton or Pers in Charge of Premises :3,tAiit-
W (please print)
Signature Title Li7,fr h
(over)
DOH-1555 (02/2004)