Goard, Gerald Thomas . I
II 1131
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Gerald Thomas Goard Male
Date of Death Age If Veteran of U.S.Armed Fort,
12/28/2021 93 Years War or Dates WWII '
F. Place of Death Hospital,Institution or
Z City,Town or Village Albany Street Address Albany Medical Center Hospital
W Manner of Death Undetermined Pending
W ❑X Natural Cause ❑Accident ❑ Homicide 0 Suicide ❑
O Circumstances Investigation
W Medical Certifier Name ? Title
CI Hanaa Shihadeh
Address
1
43 New Scotland Ave,Albany,New York 12208 `
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 3233
❑Burial Date Cemetery,Crematory or Facility Name
12/30/2021 Pine View Crematory
❑Entombment Address
X❑Cremation Queensbury Town,New York
❑Donation
Z• ❑Removal Date Place Removed
and/or and/or Held
N Hold Address
0
a Date Point of
O ❑Transportation Shipment
0 by Common
Carrier Destination
❑Disinterment
Date Cemetery Address
/
ID Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped,If Other than Above
2 Address
CC
W
EL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/29/2021 Registrar of Vital Statistics DanielleS 0/Lyle(Electronically-Signed)
(signature)
District Number 0101 Place Albany, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
qZ Date of Disposition 3 1 22., Place of Disposition na s
2 (address)
W
NCC (section) of number) (grave number)
GName of Sexton or Person in Charge of Premi s '�1" -\- civv4tt
z /pleasrint/
W a Title Cy r���
Signature �
DOH-1555(o7/18)p 1 of 2
•
01.5502
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#