Loading...
Mosher, Randolph C. 1zbg tt NEWYORKSTATEDEPARTMENTOFHEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Randolph C.Mosher Male Date of Death Age If Veteran of U.S.Armed Forces, 12/01/2020 67 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital WW Manner of Death © Natural Cause ❑Accident Homicide El Suicide ❑Undetermined Pending to Circumstances Investigation CI Medical Certifier Name Title David Cunningham MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 548 ❑Burial Date Cemetery,Crematory or Facility Name 12/04/2020 Pine View Crematory 0 Entombment Address 1 Cremation Queensbury Town,New York 0 Donation O• CIRemoval Date Place Removed and/or and/or Held Hold Address N 0 �- Date Point of N ❑Transportation p by Common - Shipment Carrier Destination 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 1— Remains are Shipped,If Other than Above 5 Address 2 W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/03/2020 Registrar of Vital Statistics Rg6ertAndrew Curtis(ECectronica1Ty Signed) (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 permit on: I- W Date of Disposition /2-5-z 'zp Place of Disposition P,'',9e C i-ei* i v 2 (addrfss) W N (section) (lot number) (grave number) O Name of Sexton or Person in Charg of Premises �� dl*/ /Please print/ ▪ Signature `"� // ,,/ Title O��T<`t�N` DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) 014250 Receipt Human remains of delivered on , 20 , Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#