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Turner, Richard A
. - as NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Richard A.Turner Male Date of Death Age If Veteran of U.S.Armed Forces, 07/26/2021 88 Years War or Dates F.„ Place of Death Hospital,Institution or 2 City,Town or Village Lake George Village Street Address 61 Mohican Street 4,Lake George Village,New York 12845 Manner of Death Undetermined Pending W ©Natural Cause ❑Accident El ❑Suicide ❑ ❑ Circumstances Investigation LIJ Medical Certifier Name Title Mary Stein NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Lake George Village 5620 4 ❑Burial Date Cemetery,Crematory or Facility Name 07/28/2021 Pine View Crematory ❑Entombment Address u Cremation Queensbury Town,New York ❑Donation g' Date Place Removed O ❑Removal and/or Held F and/or • Hold Address Cl) ❑Transportation Date Point of by Common Shipment Carrier Destination Date Cemetery Address ❑Disinterment ❑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 —. Remains are Shipped,If Other than Above M Address CC W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/28/2021 Registrar of Vital Statistics 'De6rag Mckinney(ECectronicallySigned) (signature) District Number 5620 Place Lake George Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F-" W Date of Disposition Place of Disposition �InQ V-IA.) Cdre,P►4-lorY (address) W CC (section) (lot number) (grave number) gName of Sexton or Person in Charge of Pr mises �R.,r"wY Eco re,S Z 'fplease print) W Signature ) Title C ru/ha*I DOH-1555(0 18)p l of 2 Public Health Law Sec. 4145(2b) 0'_ /1 9 Receipt 1 Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# 1