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Bassarab, Walter . . - Ig - NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex 3 Walter Bassarab Male ti Date of Death Age If Veteran of U.S.Armed Forces, 02/15/2021 74 Years War or Dates Vietnam j_ Place of Death Hospital,Institution or Z City,Town or Village Warrensburg Town Street Address 16 Burdick Avenue,Warrensburg Town,New York 12885 W Manner of Death Undetermined Pending W ©Natural Cause Accident Homicide Suicide Circumstances Investigation W Medical Certifier Name Title O Mary Stein NP Address st i�' 9 Carey Road,Queensbury Town,New York 12804 t'LL Death Certificate Filed District Number Register Number AI.,.; City,Town or Village Warrensburg 5660 4 `' ❑Burial Date Cemetery,Crematory or Facility Name 02/17/2021 Pine View Crematory Entombment v Address k J Cremation Queensbury Town,New York Donation Q ❑Removal Date Place Removed and/or and/or Held N Hold Address 0 a., Date Point of Cl) ❑Transportation p by Common Shipment ° Carrier Destination ❑Disinterment Date Cemetery Address 1 Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 r Address 3809 Main St,Warrensburg,New York 12885 ` ' Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above Address CC W 0-' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/16/2021 Registrar of Vital Statistics Pamela M GCoyd(ECectronicaltySigned) (signature) District Number 5660 Place Warrensburg, New York a I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition Lill Ill Place of Disposition i,�A IL A__ 2 (address) W Cl) (section) ( number) (grave number) CC th CC 8 Name of Sexton or Person in Charge of Pre ' s r, L, ,J4,,AA.itt z L (please pr t) LLJ .2 Signature Title ilotiblot-lat DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) • '� 14 9 Receipt Human remains of '' delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#