Walsh, Michael P NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Michael P.Walsh Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/26/2021 83 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Bolton Town Street Address 845 E Schroon River Road,Bolton Town,New York 12824
11.1
'p Manner of Death Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
G Michael Bailey NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Bolton Landing 5650 17
❑Burial Date Cemetery,Crematory or Facility Name
12/29/2021 Pine View Crematory
ElEntombment Address
lCremation Queensbury Town,New York
❑Donation
Z Removal Date Place Removed
and/or and/or Held
- Hold Address
0
O. 1-1
Date Point of
co Transportation
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
H Remains are Shipped,If Other than Above
S Address
CC
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/28/2021 Registrar of Vital Statistics Jodi Petteys(ECectronicalrySigned)
(signature)
District Number 5650 Place Bolton Landing, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
Date of Disposition f Place of Disposition Q,/ V i t,i,,J �,f c/1,q.40%
2 (address)
W
CC (section) _ (lot number) (grave number)
S Name of Sexton or Person in Charge of Premises � S rr e-y"
(please print)
Z �
W Signature , ' Title C,�C
DOH-1555(07/18)p 1 of 2
0 5 7
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on j. , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#