Dingman Sr, Ryan NEW YORK STATE DEPARTMENT OF HEALTH f # 113
Vital Records Section Burial - Transit Permit
° e Name First Middle Last Sex
Ryan S. Dingman,Sr. Male
a s Date of Death Age If Veteran of U.S. Armed Forces,
: November 21,2013 50 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Stony Creek Street Address 72 1/2 Murray Road
Manner of Death I XI Natural Cause Accident n Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
William Orluk Coroner
Address
ink Chester Health Center,Chestertown,NY 12817
Death Certificate Filed District Number Register Number
71: City, Town or Village Stony Creek 5658
❑Burial Date Cemetery or Crematory
November 26,2013 Pine View Crematory
Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
I' Hold
CO
0 Date Point of
(0 ( I Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
ri'i Name of Funeral Home Alexander-Baker Funeral Home 00037
i,i1J Address
' 3809 Main Street,Warrensburg,NY 12885
, Name of Funeral Firm Making Disposition or to Whom
iRemains are Shipped, If Other than Above
Address
.:-,j Permission is hereby granted to dispose of the h n r ins desc ' e a indicated.
w°: l Date Issued //-o9'I-c b/3 Registrar of Vital Statistic r
-1 (sig ure)
!, District Number 5658 Place Stony Creek
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z '!
tu Date of Disposition ll -11-i_3 Place of Disposition ,,,, , try-c�cr..—
W (address)
Cl)
pCe (section) (lot n tuber) (grave number)
Name of Sexton or Pers in Char a of Premises b �hrit4
Z (ple a print)
W
Signature 6 Title (,a iV._.
(over)
DOH-1555 (02/2004)