Baldwin Jr, Elton # -7IL
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Elton Joseph Baldwin,Jr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
November 26,2013 85 War or Dates
. Place of Death Hospital, Institution or
Z City,Town or Village Gansevoort Street Address 979 Saratoga Road
Ip Manner of Death 0 Natural Cause Accident 0 Homicide n Suicide 0 Undetermined Pending
Circumstances Investigation
w Medical Certifier Name Title
Mark Hoffman MD
Address
102 Park Street, Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Wilton 4569 �%
❑Burial Date Cemetery or Crematory
El Entombment November 27,2013 Pine View Crematory
Address
®Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z 0 Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
Ss. ❑Transportation Shipment
Eby Common Destination
Carrier
Disinterment Date Cemetery Address
El Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan& Denny Funeral Home 01444
Address
94 Saratoga Avenue, South Glens Falls,NY 12803
Name of Funeral Firm Making Disposition or to Whom
l— Remains are Shipped, If Other than Above
2 Address
X
W
a.
Permission is hereby granted to dispose of the human remains described above d.,indicated.
Date Issued // . �j Registrar of Vital Statistics i) 4/
w I�,
(signature)
District Number 4569 Place Wilton
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z r�
Date of Disposition (i- 21-(3 Place of Disposition 'gig Li 44.
LIJ (address)
CA
(Y
0 (section) (lot uro r) (grave number)
Z Name of Sexton or Person i Charge of Premises „ -C,' rIri-
( ease rint)
W Signature \., 4Title Cit r )j`,
(over)
DOH-1555(02/2004)