Loading...
Baird, Henry NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Henry Baird M Date of Death Age If Veteran of U.S. Armed Forces, 2-4-96 80 War or Dates Place of Death Hospital, Institution or City, Town or Village Queensbury Street Address 3 Old Coach Manor. Manner of Death®Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title Robert Sponzo MD Address Glens Falls,NY Death Certificate Filed District Number Regis r Number City, Town or Village Queens bury 5657 Date Cemetery or Crematory ❑Burial 2-6-96 Pine View Crematory ❑x Address Queensbur NY Cremation Y Date Place Removed Z ❑Removal and/or Held 0 and/or Address a5Hold R. Date Point of W ❑Transportation Shipment by Common Destination Carrier ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Adirondack Cremation Associates RegistrationVIC, r Name of Funeral Home Address Warrensburg,NY Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address A. Permission is hereby granted to dispose of the hums re ins de�;;crib a ove as indicated. Date Issued 2-5-96 Registrar of Vital Statistic K�si ature) 5657 Place T/O Queens bury,NY District Number I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: z am ��Date of Disposition ger Place of Disposition /�.C�/l f�,U CXX:XA/© t // '6LAj (address) LIJ N > (section) (lot number ) (grave number) GName of Sexto or Person in Charge of Pr ises , „� �/ /j� Z �l�' g (please print) Signature Title DOH-1555 (10/89) p. 1 of 2 VS-61