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Waldron, Howard
NEW YORK STATE DEPARTMENT OF HEALTH '` zo i Vital Records Section Burial - Transit Permit Name First Middle Last Sex Howard W. Waldron Male Date of Death Age If Veteran of U.S. Armed Forces, April 14,2012 92 War or Dates World War H t... Place of Death Hospital, InstitutioriUirondack Trii-County Health Care Z City, Town or Village Johnsburg Street Address Center W Manner of Death I X1 Natural Cause 1 1 Accident 1 1 Homicide Suicide Undetermined Pending Circumstances Investigation ywj Medical Certifier Name Title C James Hindson Dr. Address Main St.,Warrensburg,NY 12885 Death Certificate Filed District Number Register umber City, Town or Village Johnsburg 5655 I1 ❑Burial Date Cemetery or Crematory Entombment April 16,2012 [ Pine View Crematory Address ©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 N I I 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 Remains are Shipped, If Other than Above S. Address CK Ui CL Permission is hereby granted to dispose of the human rem ins described ve as indicated. Date Issued llp 6/.R. Registrar of Vital Statistics r/�/i�SC�' ` (signature) District Number 5655 Place Johnsburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: �Z u Date of Disposition �((I�(l Z Place of Disposition �.,,, vy rt�, or k.. 2 (address) COILLI aCL (section) /)l . (lot r{dmber) (grave number) Name of Sexton or Person in Charge of Premises r, i4&"", 30,4 Z (( (please print) WAL Signature Title L .mot.Tq, (over) DOH-1555 (02/2004)