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Cunningham, Patrick J
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Patrick J.Cunningham Male Date of Death Age If Veteran of U.S.Armed Forces, 07/13/2021 81 Years War or Dates 61-63 F- Place of Death Hospital,Institution or ZCity,Town or Village Johnsburg Town Street Address Elderwood at North Creek p Manner of Death ©Natural Cause Accident El Homicide El Suicide ❑Undetermined 0 Pending W Circumstances Investigation W Medical Certifier Name Title P Eric Santell NP Address 112 Ski Bowl Rd,Johnsburg Town,New York 12853 Death Certificate Filed District Number Register Number City,Town or Village North Creek 5655 22 ❑Burial Date Cemetery,Crematory or Facility Name 07/22/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ElDonation Z ❑Removal Date Place Removed and/or and/or Held _ CO Hold Address 0 C Date Point of u) ❑Transportation Shipment p by Common Carrier Destination ❑Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom F- Remains are Shipped,If Other than Above t- Address CC W n Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/16/2021 Registrar of Vital Statistics KAtf&een C.Lorah(ECectronica1Ty Signed) (signature) District Number 5655 Place North Creek, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I Z Date of Disposition )--%-J--0103 place of Disposition p;/tt. 1;G-J c,ftvw,,lr,(iy W (add ess/ W N 0 (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises d.c.( t)' 5?J. r-t'3 Z (p7ease print) W 1 CieTitle ,,v.c.r Signature DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0I 4360 Receipt Human remains of is delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit , Official Funeral Directors Reg.or License#