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Webster, John Cross i 13a- NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John Cross Webster Male Date of Death Age If Veteran of U.S.Armed Forces, 12/29/2021 101 Years War orDates i... Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ©Natural Cause ❑Accident Homicide ❑Suicide 0 Undetermined ❑Pending W Circumstances Investigation Q Medical Certifier Name Title ;a.. Shahid Ahmed MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 637 ❑Burial Date Cemetery,Crematory or Facility Name 12/30/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation ZRemoval Date Place Removed and/or and/or Held F- Hold Address In 0 N ❑Transportation 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 1 Remains are Shipped,If Other than Above 5 Address CC W , Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/30/2021 Registrar of Vital Statistics cNpbertAndrew Curtis(ECectronica1Ty 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: I- W Date of Disposition I /1 I zz Place of Disposition 'Fn1V►.r („71-�,_ 2 (address) W N (section) pot number) (grave number) ct C SName of Sexton or Person in Charge of Premises I..,r$ MM /� (pi se print) p W Signature _ �--^�( Title ` LE ' DOH-1555(07/18)p 1 of 2 731,., Public Health Law Sec. 4145(2b) J Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named qn buritlpermit Official Funeral Directors Reg.or License# `'