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Bariteau Jr., Henry A. NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit11Ql Bureau of Vital Records Name First Middle Last Sex Henry A.Bariteau Jr. Male `4 Date of Death Age If Veteran of U.S.Armed Forces, 11/10/2020 80 Years War or Dates 1957-1962 1.. Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital 1p Manner of Death ©Natural Cause 0 Accident ❑Homicide 0 Suicide Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title 9�,.,- Asim Chaudry MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 508 1-1 ' ❑Burial Date Cemetery,Crematory or Facility Name 11/12/2020 Pine View Crematory ❑Entombment Address 12 Cremation Queensbury Town,New York `_❑Donation Z, Date Place Removed O 0 Removal and/or and/or Held F- Hold Address CO l Date Point of co ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment 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 I Remains are Shipped,If Other than Above 2 Address CC Ill IZ' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/12/2020 Registrar of Vital Statistics Men Andrew Curtis(ECectronicalTySigned) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this ermit on: z' q JL 4----- W Date of Disposition li�)3/7� Place of Disposition „_� 2 (address) ILI CC (section) Al (lot number) (grave number) O Name of Sexton or Person in Charge P mises L �' 1. "t�) Z (prase prm W Signature Title G��' ��(. DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014192 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#