Jones, John Earl 301.
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
John Earl Jones Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/23/2021 51 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death
Wvt,11771 Natural Cause Ei Accident El Homicide ❑Suicide Li
Undetermined Pending
U Circumstances Investigation
WQ Medical Certifier Name Title
Marcille Labban MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 157
0 Burial Date Cemetery,Crematory or Facility Name
03/24/2021 Pine View Crematory
0 Entombment Address
0 Cremation Queensbury Town,New York
❑Donation
0 ❑Removal Date Place Removed
and/or and/or Held
F—
U Hold Address
)
0
fL Date Point of
U) ❑Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
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
1— Remains are Shipped,If Other than Above
:E Address
Cr
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/24/2021 Registrar of Vital Statistics Ro6ertf?narretvCurtts(Electronica/ySigned)
(signature)
District Number 5601 Place Glens Falls, 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 3 Jt5 Il l Place of Disposition L 0__ ___
W
2 (address)
W
(section) L(lot number) (grave number)
CName of Sexton or Person in Charge of Premi /"1 ri t /t,�t
Z (pleas riot) �^ rpm
W Signature Title ` mil{l"VC.
DOH-1555(07/18)p 1 of 2
1 t� ,; .
1 Public Health Law Sec. 4145(2b) �� ..�,
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#