Rathje, Stephen H. NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
,'- Stephen H.Rathje Male
izii
ii Date of Death Age If Veteran of U.S.Armed Forces,
01/22/2021 72 Years War or Dates
� Place of Death
Hospital,Institution or
ZCity,Town or Village Lake George Town Street Address 2180 State Route 9,Lake George Town, New York 12845
cl W Manner of Death IX" Natural Cause ❑Accident ❑Homicide ❑Suicide 0 Undetermined 0 Pending
Circumstances Investigation
W Medical Certifier Name Title
Christopher Mason DO
Address
.* 100 Park St,Glens Falls,New York 12801
°: Death Certificate Filed District Number Register Number
P City,Town or Village Lake George 5651 1
f ❑Burial Date Cemetery,Crematory or Facility Name
01/26/2021 Pine View Crematory
❑Entombment Address
14,4 0 Cremation Queensbury Town,New York
Donation
Si i
ZEl Removal Date Place Removed
and/or and/or Held
F_ Hold Address
0
Jai Date Point of
0 ❑Transportation
Q by Common Shipment
54.i Carrier Destination
y'
Disinterment
Date Cemetery Address
v£ Date Cemetery Address
Reinterment
14
_% Permit Issued to Registration Number
d,, Name of Funeral Home Alexander Baker Funeral Home 00037
Address
{ii 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
1L
a Permission is hereby granted to dispose of the human remains described above as indicated.
i 01/26/2021 Patricia
3, Date Issued Registrar of Vital Statistics �R,Mc?(jnney-Schuster(�CectronicallySigner�
(signature)
41` District Number 5651 Place
Lake George, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition (/Z71 71 Place of Disposition
7,....E. L✓►—
(address)
CL1
CC (section) (lot nu ber) (grave number)
gName of Sexton or Person in Charge of Pre ' es r+s ^'rl1
ILI Z (please print
Signature f nature � Y Title 1 ro a DOH-1555(07/18)p id 2
{
Public Health Law Sec. 4145(2b) 6..
Receipt
Human remains of delivered on , 20
/ y
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#