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Paradis, John P. a 1f-1 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John P. Paradis Male Date of Death Age If Veteran of U.S.Armed Forces, 10/30/2020 89 Years War or Dates Place of Death Hospital,Institution or uCity,Town or Village Minerva Town Street Address 974 14th Road, Minerva Town,New York 12851 p Manner of Death © Natural Cause El Accident ❑Homicide ❑Suicide ❑Undetermined El Pending Circumstances Investigation MI Medical Certifier Name Title Jennifer Stratton MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Olmstedville 1557 7 ❑Burial Date Cemetery,Crematory or Facility Name 11/03/2020 Pine View Crematory 0 Entombment Address 0 Cremation Queensbury Town,New York ElDonation Removal Date Place Removed and/or and/or Held - Hold Address to O O. Date Point of U) L j Transportation Shipment Q by Common Carrier Destination 0 Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg, New York 12885 Name of Funeral Firm Making Disposition or to Whom F— Remains are Shipped,If Other than Above ML Address W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/02/2020 Registrar of Vital Statistics Diana Mason(ECectronically Signed) (signature) District Number 1557 Place Olmstedville, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: z Date of Disposition 03)70 Place of Disposition ��... 111 (address) W CC N (section) t number) (grave number) Name of Sexton or Person in Charge of mises Z (pleas print) /' Wtmt Signature Title `�' �� DOH-1555(07/18)p tiff 2 y A r Public Health Law Sec. 4145(2b) 0 I Ivry! 6 Receipt Human remains of delivered on / , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#