Call, Ramond Henry 3 TO
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First's Middle Last Sex
Raymond Henry Call Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/26/2021 88 Years War or Dates 1953-1955
Place of Death Hospital,Institution or
City,Town or Village Queensbury Town Street Address 39 Longview Drive Apt 203,Queensbury Town,New York 12804
▪ Manner of Death Pending
G �Natural Cause �Accident �Homicide �Suicide �Undetermined �
W Circumstances Investigation
W Medical Certifier Name Title
Robert Love MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 101
El Burial Date Cemetery,Crematory or Facility Name
04/28/2021 Pine View Crematory
ElEntombment Address
QCremation Queensbury Town,New York
EiDonation
Z Removal Date Place Removed
and/or and/or Held
Hold Address
O
t3. Date Point of
Cl) ❑Transportation Shipment
$ by Common
Carrier Destination
11
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
Remains are Shipped,If Other than Above
a Address
Q
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/27/2021 Registrar of Vital Statistics Carnlinexfgarde Barger(ElectronicalySigned,
(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:
Z
Date of Disposition 9 114 ill Place of Disposition G,
W (address)
W
CC (section) /�'number) 11.(grave number)
CC
gName of Sexton or Person in Charge of Premis re
Z (please,Wilt)
W Title � obtiVt
Signature
DOH-1555(07/18)p i of 2
Public Health Law Sec. 4145(2b) 0147
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#