Steele, Jordan NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit ermit
Name First Middle Last Sex
Jordan Steele Male
Date of Death Age If Veteran of U.S. Armed Forces,
June 20,2013 80 War or Dates
H Place of Death — Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death X Natural Cause ! !Accident I Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
Joseph C.Mihindu MD
Address
20 Murray Street,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls,NY 5601 �63
❑Burial Date Cemetery or Crematory
Entombment June 24,2013 Pine View Crematory
Address
0 Cremation 21 Quaker Rd.,Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
0 Date Point of
u) Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00035
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
i— Remains are Shipped, If Other than Above
2 Address
Ltr
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 6-24-13 Registrar of Vital Statistics Gu. R,w
(sign ure)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 4-jf-13 Place of Disposition .�9,,, ,�
W (address)
(section) � .. (lot numbe� (grave number)
pName of Sexton or Person in Charge f Premises ,�� 14 J
�Z (please print)
Signature ,,, Title CarP119
(over)
DOH-1555(02/2004)