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Stewart, Richard C
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit ermit Bureau of Vital Records Name First Middle Last Sex Richard C.Stewart Male Date of Death Age If Veteran of U.S.Armed Forces, 10/08/2021 80 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village North Creek Hamlet Street Address 296 Peaceful Valley Road,North Creek Hamlet,New York 12853 p Manner of Death © Natural Cause El Accident ❑Homicide ❑Suicide Undetermined Pending (Wj Circumstances Investigation G Medical Certifier Name Title Nicholas Montello NP Address 9 Carey Road,Queensbury Town, New York 12804 Death Certificate Filed District Number Register Number City,Town or Village North Creek 5655 40 ❑Burial Date Cemetery,Crematory or Facility Name 10/13/2021 Pine View Crematory ❑Entombment Address 0 Cremation Queensbury Town,New York ❑Donation 0 Removal Date Place Removed and/or and/or Held Hold Address 0 O. Li Date Point of p by Common Shipment Carrier Destination Disinterment Date Cemetery Address 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 F- Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/12/2021 Registrar of Vital Statistics 7Cathleen C.Lorah(ECectronica1ty Signed) (signature) District Number 5655 Place North Creek, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition /t0 9- 202/ Place of Disposition /711'1e Gt./ G fBma, LU (address) // W N Cr (section) (lot number) (grave number) Name of Sexton or Person i harge of Premises h /rr4vt 64 (please print) W Signature Title C reryac. toy �pc.r�,�✓ DOH-1555(07/18)p t of / 01. "a229 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 ` I l , • Pie View Cemetery Representing the funeral home named onh rial permit Official Funeral Directors Reg.or License# ` ' ;