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Kirker, John Alden N EW PORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John Alden Kirker Male Date of Death Age If Veteran of US.Armed Forces, 08/07/2021 79 Years War or Dates }.. Place of Death Hospital,Institution or 2 City,Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide Undetermined 0 Pending U Circumstances Investigation WQ Medical Certifier Name Title Shahid Ahmed MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 - 335 IDBurial Date Cemetery,Crematory or Facility Name 08/11/2021 Pine View Crematory El Entombment Address X❑Cremation. Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held ~ Hold Address CO V1 ❑Transportation Date Point of $ by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom F.. Remains are Shipped,If Other than Above g Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/11/2021 Registrar of Vital Statistics Wpbert Andrew Curtis(E(ectronically Signed) (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: Date of Disposition f I it(11 Place of Disposition 40-----.. ILI (address) W Q (section) � (lot number) (grave number) if G Name of Sexton or Person in Charge of Premises Al}y'�., �iti•+t4 Z /p/e a print/ ar ;����JJ IliCf�`�--Signature �.� Title DOH-1555(07/18)p 1 of 2 015030 Public Health Law Sec. 4145(2b) 1 Receipt Human remains of delivered on 'r, 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# —