Loading...
Powers, Garry M NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Garry M.Powers Male Date of Death Age If Veteran of U.S.Armed Forces, 09/14/2021 74 Years War or Dates Vietnam F- Place of Death Hospital,Institution or WCity,Town or Village Warrensburg Town Street Address 4 Cloverleaf Drive,Warrensburg Town, New York 12885 p Manner of Death © Natural Cause 0 Accident / EiHomicide 0 Suicide 0 Undetermined El Pending W U Circumstances Investigation W Medical Certifier Name Title 0 John Lukaszewicz MD Address 101 Ridge Street 2,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Warrensburg 5660 23 ❑Burial Date Cemetery,Crematory or Facility Name 09/20/2021 Pine View Crematory ❑Entombment Address 0 Cremation Queensbury Town,New York EtDonation Date Place Removed Removal and/or Held H and/or CO Address 0 Date Point of U) Li Transportation Shipment p by Common Carrier Destination El Disinterment Date Cemetery Address ID 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 1— Remains are Shipped,If Other than Above 5 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/17/2021 Registrar of Vital Statistics 'Pame[a.2 Lloyd-(ElectronicallySigned) (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— 7 W Date of Disposition `9 1101'Zi Place of Disposition �.0 ti�d(address) � o r+~ W N (section) , (lot number) (grave number) CC S Name of Sexton or Person in Charge of P ises C L.- —co%4H (p/e a print) Z lK""w1- W a— Title 04 Signature DOH-1555(o7/18)p 1 of 2 `€_ 56 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# - Rr