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Altman, Charles P 30 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Charles B. Altman Male Date of Death Age If Veteran of U.S. Armed Forces, May 20,2013 82 War or Dates Korean Place of Death Hospital, Institution or Z City, Town or Village Johnsburg Street Address 797 S. Johnsburg Road O Manner of Death X Natural Cause Accident I I Homicide Suicide Undetermined Pending Circumstances Investigation u Medical Certifier Name Title O Dr.James Hicks,MD Address HHHN,North Creek,NY 12853 Death Certificate Filed District Number Register Number City, Town or Village Johnsburg 5655 /o2 ❑Burial Date Cemetery or Crematory May 22,2013 Pine View Crematory Entombment Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed Z Removal and/or Held and/or Address Hold O Date Point of NTransportation 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 1- Remains are Shipped, If Other than Above 2 Address W Permission is hereby granted to dispose of the human remains describedip•ve as indicated. Date Issued c5 c? c7//3 Registrar of Vital Statistics /.J ' e � . (signature) District Number 5655 Place Johnsburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: O Date of Disposition 613/3 Place of Disposition /?_v,t Vlea (address) W N re (section) , lot nu ber) (grave number) pName of Sexton or ers n in rge of Premises �� ii A owy,t., ci 'Z J (pllea�see print) Signature 1 (� Title ��, y�)0'44X- A3+- (over) DOH-1555 (02/2004)