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Bailey Jr., Howard Joseph !\.. H Z 51 NEWYORKSTATEDEPARTMENTOFHEALTH 2 Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Howard Joseph Bailey Jr. Male Date of Death Age If Veteran of N4rmed Forces, 03/05/2021 91 Years War or Dates 1953-1955 p.., Place of Death Hospital,Institution or WCity,Town or Village Bolton Town Street Address 14 S Beach Avenue,Bolton Town,New York 12814 p Manner of Death ©Natural Cause .0 Accident ❑ Homicide 0 Suicide ❑Undetermined El Pending Circumstances Investigation W Medical Certifier Name Title a Bryan Smead MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number ,City,Town or Village Bolton Landin 5650 4 ❑Burial Date fline metery,Crematory or Facility Name 03/09/2021 View Crematory 0 Entombment Address • 0 Cremation Queensbury Town,New York ❑Donation 0 Z Removal Date Placed p and/or and/or Held N Hold Address ( ffy Transportation Date Point of b by Common Shipment Carrier Destination 11 Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 2 Address Er W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/09/2021 Registrar of Vital Statistics Jodi 4'etteys(ECectronicafIy Signed) (signature) District Number 5650 Place Bolton Landing, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Zj W Date of Disposition ��)dl Z� Place of Disposition ?IL :�'s/ W N Q (section) (lot number) (grave number) L 0 Name of Sexton or Person in Charge of Premises ft) J w wu �d (pleas print) tL Signature �.� ; Title `i✓riol+OIt DOH-1555(07/18)pi of 2 Public Health Law Sec. 4145(2b) 0 1 4 22 Receipt I Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#