Kunz, Jr. Harold g 54.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Harold G. Kunz,Jr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
January 5,2018 78 War or Dates Vietnam
Place of Death Hospital, Institution or
City, Town or Village Lake George Street Address 71 Olde Coach Road
Manner of Death
1Natural Cause Accident I I Homicide Suicide Undetermined Pending
Circumstances Investigation
_u= Medical Certifier Name Title
O Christopher D.Hoy
Address
102 Park Street,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Lake George 5651
❑Burial Date Cemetery or Crematory
January 9,2018 Pine View Crematory
El Entombment
Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
O and/or Address
H Hold
CO
o Date Point of
N Transportation Shipment
'p by Common Destination
Carrier
Disinterment Date Cemetery Address
pi Reinterment Date Cemetery Address
`-' Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
,, 3809 Main Street,Warrensburg,NY 12885
_. Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
..,, Permission is hereby granted to dispose of the human re ains descri ed above as indicated.
Date Issued i Registrar of Vital Statistics (e,(,!y p� ?,.,!, .Icill` (signature)
District Number 5651 Place T/O Lake George
i—
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition //9lig Place of Disposition giltV..r 4S...,,
2 (address)
W
CO
CL (section) rtri,00,..-(lot numb ) (grave number)
pName of Sexton or Person in Charge of Pre ises I-47
Z (Obese pnnt)
Signature Title 4'�'FNii #L
(over)
DOH-1555 (02/2004)