Loading...
Goodman, Edward G. / NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Edward G.Goodman Male Date of Death Age If Veteran of U.S.Armed Forces, Iis 01/06/2021 93 Years War or Dates WWII Place of Death Hospital,Institution or Z City,Town or Village Johnsburg Town Street Address 589 Goodman Road,Johnsburg Town, New York 12843 W Manner of Death © Natural Cause p Accident 0 Homicide 1=1 Suicide 0 Undetermined 0 Pending ILI Circumstances Investigation 0 Medical Certifier Name Title John Quaresima MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village North Creek 5655 2 Burial Date Cemetery,Crematory or Facility Name 01/11/2021 Pine View Crematory ❑Entombment Address , Eti Cremation Queensbury Town,New York , ❑Donation ZRemoval Date Place Removed and/or and/or Held , Hold Address CO 0 a Date Point of U) ❑Transportation O by Common Shipment i,- Carrier Destination '` ❑Disinterment Date Cemetery Address f 12 Reinterment Date Cemetery Address 4, 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 N Remains are Shipped,If Other than Above 2 Address CC aPermission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/09/2021 Registrar of Vital Statistics XRtf&en C.Gorak(ECectronica1tySigned) (signature) District Number 5655 Place North Creek, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: .�W` Date of Disposition I ill ill Place of Disposition �, 2 (a dress) WCO Cc (section) I(lot number) (grave number) a' Name of Sexton or Person in Charge of Premis /'t rp�-' `�'�ti�� all (ple se print) Signature Title (W s avoie DOH-1555(07/18)p 1 of 2 r e . Public Health Law Sec. 4145(2b) ¢ 14 -� Receipt Human remains of delivered on , 20 /Ad FI � Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#