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Wajda, Walter F _,___ ♦ t (IOZ NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle 44 Last Sex Walter F.Wajda Male Date of Death Age If Veteran of U.S• 12/17/2021 87 Years War or Dates F,. Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death © Natural Cause Accident Homicide ❑Suicide ❑ ❑Undetermined Pending Circumstances Investigation W Medical Certifier Name Title CI Asim Chaudry MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 618 ❑Burial Date Cemetery,Crematory or Facility Name 12/23/2021 Pine View Crematory Entombment Address ElCremation Queensbury Town,New York ❑Donation ZO Removal Date Place Removed and/or and/or Held ~ Hold Address CO 0 d Date Point of fA ❑Transportation Shipment Q 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 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/22/2021 Registrar of Vital Statistics Men 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: Z W Date of Disposition !LID 121 Place of Disposition '7„� t,/1-air--- 2 (address) W CCCC (section) (lot number) (grave number) gName of Sexton or Person in Charge of Premises d rktU S"M z /J� (pl se print) W Signature Title ll?>F/w'b' j+rJ_ DOH-1555(07/18)p i of 2 Public Health Law Sec. 4145(2b) ` 1 . Receipt Human remains of delivered on , 20 fT ,r Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#