Cameron Sr, Daniel 4 v1
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Daniel Lee Cameron,Sr. Male
Date of Death ' Age If Veteran of U.S. Armed Forces,
March 25,2014 73 War or Dates Vietnam
i— Place of Death Hospital, Institution or
Z City, Town or Village T/O Thurman Street Address 2 Mountain Road
tu
a Manner of Death Undetermined Pending
Natural Cause Accident � �Homicide Suicide
ILI Circumstances Investigation
0
w Medical Certifier Name Title
a Nancy Carney Dr.
Address
HUHN,Wrg.,NY 12885
Death Certificate Filed District Number Registe.Number
City, Town or Village Thurman 5659
❑Burial I Date ; Cemetery or Crematory
❑Entombment March 27,2014 Pine View Crematory
Address
Ex Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
1.7 Holdrn i
0 Date Point of
Transportation Shipment
a by Common Destination
Carrier
j Disinterment Date ' Cemetery Address
Reinterment Date Cemetery Address
I
Permit Issued to 1 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
i— Remains are Shipped, If Other than Above
E Address
iY
w
O.
Permission is hereb
y gr nted to dispose of the human/re-pains, escribed-0b e s ind eated.
Date Issued 1 " Registrar of Vital Statistics ' C �
(signat re)
District Number 5659 / Place Thurman
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z �
w Date of Disposition 3 8- (17 Place of Disposition A)/l!e tbee.,,1 vt74��
2 (address)
11.1
re (section) (tot number) (grave number)
PI Nameof Sexton Person ' arge of Premises Se'4.,/,
i1// c�
iZ / (p/"ease pr
Signature Title ���� int) 7.
(over)
DOH-1555 (02/2004)