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Murray, Charles J. ft --)a NEW YORK STATE DEPARTMENT OF HEALTH " Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Charles J.Murray Male Date of Death Age If Veteran of U.S.Armed Forces, 01/18/2021 69 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing W Manner of Death Undetermined Pending © �Natural Cause �Accident �Homicide �Suicide W U Circumstances Investigation W Medical Certifier Name Title CI Wendy Steinhacker PA Address 42 Gurney Ln,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 21 ElBurial Date Cemetery,Crematory or Facility Name 01/21/2021 Pine View Crematory 0 Entombment Address gCremation Queensbury Town,New York 0 Donation Z In Date Place Removed 0 and/or Removal and/or Held I- -(J) Hold Address 0 G. Date Point of U) ❑Transportation Shipment p by Common Carrier Destination 0 Disinterment Date Cemetery Address Date Cemetery Address 0 Reinterment Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom .- Remains are Shipped,If Other than Above N Address li W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/21/2021 Registrar of Vital Statistics Caroliine9-adegar�e Bader(Ekctromcal5,Signed) (signature/ District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H W Date of Disposition 'a 2Z 12/ Place of Disposition `_'ii IL �o 2 (address) Ch CC (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge f Premises "p``` yan4 � (plea print) W Signature G^� �,�'T— Title itiWt4 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 1 4 4 2 Receipt Human remains of delivered on , 20 • Pine View Cemetery Representing ihe funeral home named on burial permit Official Funeral Directors Reg.or License# _ ,