Baker, Darren NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
:: Name First Middle Last Sex
Darren T. Baker Male
Date of Death Age If Veteran of U.S. Armed Forces,
Feb. 21 , 2014 38 War or Dates
Place of Death Hospital, Institution or Westchester Medical Center
Town of Mt: Pleasant
Z City,Town or Village Street Address Valhalla. New York 10595
ci Manner of Death C Natural Cause Accident 0 Homicide Suicide Undetermined Pending
U Circumstances Investigation i
-W Medical Certifier Name Title
Q xeyiir Thakur MD.
Address
Westchester Medical Center, Valhalla, New York 10595
ilai Death Certificate Filed Town of Mt. Pleasant District Number 5957 Register Number
. City,Town or Village
El Burial Date Cemetery or Crematory
March 5, 2014 Pine View Crematory
>': ❑Entombment Address
OCremation Quaker Road; Queensbury, NY 12804
' Date Place Removed
Z Removal and/or Held
and/or Address
Hold
0 Date Point of
Transportation Shipment
is by Common Destination
Carrier
ilik0 Disinterment Date Cemetery Address
0 Reinterment
' Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
<: Address
53 Quaker Road, Queensbury, NY 12804
<` Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above •
Address
tit
Permission is hereby granted to dispose of the human rema ` escribed ab ve as indic ted.
s .
Date Issued Registrar of Vital Statistics 4'` - .
s. nature)
District Number 5957 Place One Town Hall Plaza, Valhalla, New York 10595
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z /�
0.1 Date of Disposition 3111 f ig( Place of Disposition 'f.� a a c 1-.
(address)
(section) (lot number) (grave number)
CI Name of Sexton or Person in harge of Premises rig .4
(please print)
Signature Title t �'1VtT�
T-
(over)