Bump, Joshua 6 NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section \ Burial - Transit Permit
tr" Name First Middle Last Sex
Joshua R. Bump Male
' Date of Death Age If Veteran of U.S. Armed Forces,
June 25,2014 32 War or Dates
i,.-] Place of Death Hospital, Institution or
, City, Town or Village Minerva Street Address Route 28N
tit
a Manner of Death —
Natural Cause Accident I 1 Homicide X Suicide Undetermined Pending
Circumstances Investigation
w Medical Certifier Name Title
Francis Varla
Address
,Ticonderoga,NY 12883
Death Certificate Filed District Number Registe- Number
City, Town or Village Minerva 1557 �S
❑Burial Date Cemetery or Crematory
❑Entombment June 30,2014 Pine View Crematory
Address
ID Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
O and/or Address
H Hold
N
0 Date Point of
Ni !Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
=1 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
a*I Address
Ail
'" ' Permission is hereby granted to dispose of the human r 'ns described above as indicated.
Date Issued 1p)' c ),,D0 14 Registrar of Vital Statistics a-' -e51-----'
(signature)
District Number 1557 Place Minerva
I certify that the remains of the decedent identified above were disposed of in
accordanceJ with this permit on:
Z 'ling...� Date of Disposition �� �-( Place of Disposition i,� �,, �,I},�
W (address)
pCe (section) (lot number) (grave number)
Name of Sexton or Perso in Charge of Premises �,, `�1t f S[n„�
Z (please print)
W
Signature el Title (yijizw ,
(over)
DOH-1555 (02/2004)