Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Ross, Mark A
V(JO1ti, NEW YORK STATE DEPARTMENT OF HEALTH111\ Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Mark A.Ross Male Date of Death Age If Veteran of U.S.Armed Fames. 12/17/2021 55 Years War or Dates 1985-1989 1— Place of Death Hospital.Institution or Z City,Town or Village Warrensburg Town Street Address 3664 Main Street 19,Warrensburg Town,New York 12885 p Manner of Death © Natural Cause Accident ❑Homicide Suicide Undetermined El Pending Circumstances Investigation W Medical Certifier Name Title 0 Lynn Keil PA Address 1340 State Route 9,Lake George Town, New York 12845 Death Certificate Filed District Numbe Register Number City,Town or Village Warrensburg 5660 31 ❑Burial Date Cemetery,Crematory or Facility Name 12/21/2021 Pine View Crematory ❑Entombment Address ]Cremation Queensbury Town,New York ❑Donation Z 0 Removal bite Place Removed and/or and/or Held H Hold Address N 0 d Date Point of V) Li Transportation Shipment p by Common 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 1— Remains are Shipped,If Other than Above a Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/21/2021 Registrar of Vital Statistics 4'ame(a M Ethyl(ECectronicallySigned) (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 P-1 u 171 Place of Disposition , L ,.s�o �t !,,._ 2 (address) W N CC (section) (lot number) (grave number) g Name of Sexton or Person in Charge of Prem' es f'° silly )� Z (pleas print) LLI Signature �� Title 6vl l�a- DOH-1555(07/18)p 1 of 2 f . - 01_.5 46 Public Health Law Sec. 4145(2b) Receipt 1q Human remains of delivered on , 20 , Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#