Duell, Calvin P. - . , i \3 � I
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
rya Calvin P.Duell Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/20/2020 79 Years War or Dates Vietnam
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death XI Natural Cause Accident ❑Homicide ❑Suicide ❑Undetermined 0 Pending
Circumstances Investigation
CO Medical Certifier Name Title
Michael Bell MD
Address
if:,'° 9 Carey Road,Queensbury Town, New York 12804
Death Certificate Filed District Number Register Number
,, City,Town or Village Glens Falls 5601 588
,' Burial Date Cemetery,Crematory or Facility Name
12/24/2020 Pine View Crematory
a° �❑Entombment
Address
S X❑Cremation Queensbury Town,New York
❑Donation
Z Date Place Removed
0 ❑Removal
and/or and/or Held
(=
N Hold Address
0
0 ❑Transportation
Date Point of
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
F' Reinterment Date Cemetery Address
"ro
, Permit Issued to Registration Number
5„
Name of Funeral Home Alexander Baker Funeral Home 00037
5' Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
5 Address
CC
W
Permission is hereby granted to dispose of the human remains described above as indicated.
*', Date Issued 12/24/2020 Registrar of Vital Statistics W96ertAndrew Curtis(Electronically 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:
Z l
W Date of Disposition /oZ a�1 2d Zo Place of Disposition P. f�( tit` C Pr -fU `(
2 /addresst-
w
NCC (section) !lot fumber (grave number/
8 Name of Sexton or Person in Charge of Premises A t'i v., ) E. ("do
(please print)
LLI Signature : 5- ��/1/' Title Q6,4) `1+7 I—
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 01_4 3 3 2
r_ 2 4
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#