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Baker, Kerry L r Ir_ NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kerry L.Baker Male Date of Death Age If Veteran of U.S.Armed Forces, 08/22/2021 69 Years War or Dates 70-72° Place of Death Hospital,Institution or WCity,Town or Village Warrensburg Town Street Address 5 Horicon Avenue,Warrensburg Town, New York 12885 p Manner of Death © Natural Cause ❑Accident Homicide El Suicide Undetermined ❑Pending W U Circumstances Investigation W Medical Certifier Name Title CI Suzanne Bergin DO Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Registe it'.F City,Town or Village Warrensburg 5660 20 Burial Date Cemetery,Crematory or Facility Name 08/25/2021 Pine View Crematory ElEntombment Address ElCremation Queensbury Town,New York ElDonation Removal Date Place Removed and/or and/or Held N Hold Address O. Date Point of t/) ❑Transportation Shipment by Common Carrier Destination El Disinterment Date Cemetery Address El 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 i— Remains are Shipped,If Other than Above Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/24/2021 Registrar of Vital Statistics Eame(a M L1oye (ECectronicatTy Signed) (signature) District Number 5660 Place Warrensburg, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I-W Date of Disposition g. )_.S-)-1 Place of Disposition Vj hi., VA \. 22 G�4 i 1C cy (address) W N (section) (lot number) (grave number) 8 Name of Sexton or Person in Charge of Premises i4 1✓y zAI (please print) W Signature Title rc,r,G7G r DOH-1555( 18)p1of2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#" '' `t