Colton, Kevin r . , ff - I
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
#A Name First Middle Last Sex
: > Kevin F. Colton Male
ka Date of Death Age If Veteran of U.S. Armed Forces,
December 15,2014 59 War or Dates
4.A Place of Death Hospital, Institution or
City, Town or Village Chester Street Address 10 Murphy Road, Chestertown
pia Manner of Death Natural Cause Accident Homicide X Suicide Undetermined Pending
Circumstances Investigation
= Medical Certifier Name Title
° Gary Scidmore Coroner
:„ Address
_.. 6930 State Rt.8 Brant Lake,NY 12815
"x.::: Death Certificate Filed District Number Register Number
City, Town or Village T/O Chester 5652 /f
❑Burial Date Cemetery or Crematory
Ill Entombment December 17, 2014 Pine View Crematory
Address
❑x Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
zO n Removal and/or Held
and/or Address
Hold
Cl)
0 Date Point of
EL y n Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
%@_ Permit Issued to Registration Number
a ,= Name of Funeral Home a Alexander-Baker Funeral Home e 00037
a y Address
Ak g 3809 Main Street, Warrensburg,NY 12885
:gym= Name of Funeral Firm Making Disposition or to Whom
P Remains are Shipped, If Other than Above
Address
14
141
Permission is hereby granted to dispose of the human r mains esc ib ve a indicate .
* Date Issued 12-17-2014 Registrar of Vital Statistics
(signature)
E District Number 512 S'Z ?lace T/O Chester,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition it1 ii//y Place of Disposition Z. IL%) Cr fori•.
2 (address)
W
tY (section) i
- (lot nu ber) (grave number)
pName of Sexton or Person 'n Charge of Premises r�,, ive-
Z (please print)
Signature 1 .. Title 6ti:1Art
(over)
DOH-1555 (02/2004)