Cornea, Liviu • ! 76
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Liviu C. Cornea Male
Date of Death Age If Veteran of U.S. Armed Forces,
January 22,2013 79 War or Dates
>- 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 I Homicide Suicide Undetermined Pending
Circumstances Investigation
U
W Medical Certifier Name Title
Daniel Way
Address
H HN,North Creek,NY 12853
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 3 _
D Burial Date Cemetery or Crematory
❑Entombment January 23,2013 Pine View Crematory
Address
Ei Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
OZ Removal and/or Held
and/or Address
H Hold
to
O Date Point of
coTransportation 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
i- Remains are Shipped, If Other than Above
2 Address
CC
Permission is hereby granted to dispose of the human remains described above,as indicated.
Date Issued ► ) 2.3 /t 3 Registrar of Vital Statistics [/OCc.v5.,-•R, 1.1\-)
n (signatur
District Number 5601 Place Glens Falls) t v 9
I certify that the remains of the decedent identified above were disposed off in accordance with this permit on:
WDate of Disposition 1.7S^i3 Place of Disposition Rog.,
W (address)
N
(section) ,(lot number) ( (grave number)
Z Name of Sexton or Person in Char of Premises 3L4.4 }"
please print)
Signaturele., Title CIUMIr{iVi
(over)
DOH-1555 (02/2004)