Gerrard, James LOF
Town of Queensbury
Certification of Cremation
Pine View Cemetery and Crematory
This certifies that the remains of: James Gerrard
were cremated on July , 29 20 21 at the Pine View
(Month) (Day)
Crematorium, Queensbury,New York, and these are the cremated remains of said body.
Date of Death July 21 20 21 Age 89
(Month) (Day)
Funeral Home Baker Registered No. 620
uthoriz d Signature)
GERRARD 0.i...7_5- Age:
NAME James Gerrard 89
Lot Owner: James A Gerrard
Lot# Erie 80 B Grave# 1
Case: Urn
Died: 7/21 /2021 Interred8/6/2021
Funeral Home: Baker FH
Cemetery: Pine View
07/28/2021 10 :29:51 AM -0400 FAXCOM .,,4 PAGE 2 OF 2
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
JAMES A GERRARD , Male
Date of Death Age If Veteran of U.S.Armed Forces,
July 21,2021 89 War or Dates 01/30/1951-01/23/1956
H Place of Death Hospital, Institution or
W City, Town or Village Albany Street Address DVAMC 113 Holland Avenue Albany,NY 12208
8 Manner of Death j Natural Cause 0 Accident Homicide f Suicide ri Undetermined ri Pending
V Circumstances Investigation
W Medical Certifier Name Title
G RICHA KAUSHIK • MD.
•
Address
r 113 Holland Avenue Albany,NY 12208
Death Certificate Filed Alban District Number Register Number
City,Town or Village y 0198 042
❑Burial Date Cemetery or Crematory,0
�t)1\i ac,'3.03-k i r CcUA.z-6-
0 Entombment Address 1 ` v,�`� Y
®Cremation �U2,l�C �66� �0-ec�an��y t �� ,"a_s,oci
Z Removal Date Place Removed
Z❑and/or and/or Held
Address
W Hold
O Date Point of
Si Transportation 0 Po •
Shipment
O by Common Destination
Carrier
Disinterment Date Cemetery Address
•
Reinterment•
Date Cemetery Address
Permit Issued to Registration Number
` Name of Funeral Home
Address
•
Name of Funeral Firm Making Disposition or to Whom
I-= Remains are Shipped, If Other than Above
2 Address
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued July 21,2021 Registrar of Vital Statistics James Arrington
(signature)
. District Number 0198 Place DVAMC, 113 Holland Avenue, Albany,New York 12208
1. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
113 Date of Disposition 7- —-.i..d Place of Disposition D;t,{ VA,) fie,,;;,-icr y
W (address)
CO
Ce (section) (lot number)
(grave number)
pName of Sexton or Person in Charge of Premises �Q f M�-y' St) �(�
Z (please print)
W Signature /�M< 4,,,e,_,, Title (`'tire'•"Or
(over)
DOH-1555(02/2004)
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