Vogel, Joseph NEW YORK STATE DEPARTMENT OF HEALTH 4- ' 4 " 3b5--
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Joseph Peter Vogel Male
Date of Death Age If Veteran of U.S. Armed Forces,
06/06/2017 62 years War or Dates
1- P of Death Hospital, Institution or
Ci Tow it Street Address
anner of Death N tural Cause ❑Accident ❑Homicide ❑Suicide Elndetermined ❑Pending
ItiCircumstances Investigation
la Medical Certifier Name Title
L0 Paul Bachman Coroner
Address
Warrensburg Health Center, Warensburg, NY ch Certificate Filed District Number Register Number
City)TowRm*/iljXX Glens Falls 5601 276
urial Date Cemetery or Crematory
❑Entombment 06/08/2012 Pineview Crematory
Address
•
ematio-ri Queensbury. N Y 12304
Date Place Removed
Z❑Removal and/or Held
id and/or
� Address
U)
Hold
O Date Point of
Q 0 Transportation Shipment
G by Common Destination
Carrier
El Disinterment Date Cemetery Address
❑Reinterment •. Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D. Baker Funeral Home 01130
Address
11 Lafayette Street Queensbury, N Y 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above •
a Address
tr
l
P'• Permission is hereby granted to dispose of the human remains describb, above s i c ted.
9 i�2ij�
Date Issued 06/OS/LOi2 Registrar of Vital Statistics
(signature)
District Number /5601 Place Glens Falls / / 1
1' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
Iti Date of Disposition &l it f i t Place of Disposition P„m0i,t..) CrfrAit onto.
(address)
III
CC (section) / (lot number) c (grave number)
Name of Sexton or Person in Charge Premises ft ust r Sea�tN-
2 lease print)
/41kam. SignatureTitle NIAT
(over)
DOH-1555 (02/2004)