Baker, Paul 41.
NEW YORK STATE DEPARTMENT OF HEALTH • ~,il 56
Vital Records Section Burial - Transit ermit
Name First Middle Last Sex
Paul Arnold Baker Male
Date of Death . Ave, If Veteran of U.S. Armed Forces,
October 22, 2012 53 War or Dates
Place of Death Hospital, Institution or
w , Town or Village Glens Falls Street Address Glens Falls Hospital
CI Manner of Death ID Natural Cause 0 Accident 0 Homicide 0 Suicide 0 Undetermined r-i0 Pending
UI Circumstances Investigation
W Medical Certifier Name Title
C' Marvin Davidowitz, M.D
Address
100 Park Street Glens Falls, NY 12801
Death Certificate Filed District Number Register N�rnb r
it7 Town or Village 6lrh S 1�r// ���/, A/� v
❑Burial Date Cemetery or Crematory
Pine View Crematorium
0 Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
'z Removal and/or Held
and/or Address
g Hold
tli Date Point of
❑ Transportation Shipment
tO by Common Destination
CI Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
;rip Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
1' Remains are Shipped, If Other than Above
Address
Ce
Ili
1m Permission is hereby granted to dispose of the hum remains escribed bowie as i,dicat dd.
Date Issued /d �3 o/( ._ Registrar of Vital Statistics p .. ,,t-, ` A- 4 "��
/ / (signature)
District Number .S60/ Place 6/t° S k J / 7 / D/
• I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z' Date of Disposition 10-7S 17 Place of Disposition �' C ufot'tt.--
W P P
(address)
W'
(section) /� (lot number) �, �Q (grave number)
ci• Name of Sexton or P son in Charg of Premises
G ����� �` "
Z (please print)
.41 Signature Title Cfl+`M 4'C4) .i
(over)
DOH-1555 (02/2004)