Doyle, John it
NEW YORK STATE DEPARTMENT OF HEALTH ��
Vital Records Section f 244 Burial - Transit Permit
Name First Middle Last Sex
John D. Doyle Male
Date of Death Age If Veteran of U.S. Armed Forces,
January 24, 2013 88 War or Dates
1,- 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
:lei. Medical Certifier Name Title
'.0 Susan Susan Blood
Address
k ; 14 Manor Drive,Queensbury,NY 12804
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 3 b
❑Burial Date Cemetery or Crematory
February 1,2013 Pine View Crematory Entathment
Address
®Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
2 I I Removal and/or Held
O and/or Address
F' Hold
N
0 Date Point of
y Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
I
(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
,Il► Remains are Shipped, If Other than Above
M: Address
Ui0.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued i / 2,5 / I Registrar of Vital Statistics W C./CAI,-\_,s2, LA)
(signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 2-11-13 Place of Disposition -c7:iOk,, C rvi--
W (address)
co
cc
(section) (lot number) (grave number)
p Name of Sexton or Person in Charge of Premises %rl
Z (pl se print)
Ill
Signature (4 -- Title C(2. 4-
(over)
DOH-1555 (02/2004)