Wilkins, Paul Joseph NEW YORK STATE DEPARTMENT OF HEALTH ` ' Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Paul Joseph Wilkins Male
Date of Death Age If Veteran o orces,
01/19/2022 65 Years War or Dates
F— Place of Death Hospital,Institution or
Z City,Town or Village Fort Ann Town Street Address 99 Taylor Woods Road, Fort Ann Town,New York 12887
W Manner of Death Undetermined Pending
W Natural Cause Accident Homicide Suicide
Circumstances Investigation
W Medical Certifier Name Title
C Aqeel Gillani MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Fort Ann 5754 3
ElBurial Date Cemetery,Crematory or Facility Name
01/21/2022 Pine View Crematory
❑Entombment Address
0 Cremation Queensbury Town,New York
❑Donation
Z• Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
0
O. Date Point of
Cl) ❑Transportation
p by Common Shipment
Carrier Destination
❑Disinterment
Date Cemetery Address
❑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
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/21/2022 Registrar of Vital Statistics Baraaraf'hiclrell(EkctronicallySOnea)
(signature)
District Number 5754 Place Fort Ann, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit 1onnI: /�
~ DispositionW [ fj
Z Date of ��Zi �Z2 Place of Disposition �,,t, t.._ ,....
W
2 (address)
W
COCC (section) (lot number) (grave number)
• Name of Sexton or Person in Charge of Pre ' es A 6 �p("'� �'1M tt
(vlease print)
Z y
W ('
Signature Title l MC mr}1
DOH-1555(07/18)p 1 of 2
!)i5571-
Public Health Law Sec. 4145(2b)
Receipt
Human remains of ` 1+ ' delivered on 1 , 20
Pine View Cemetery Representing the funeral home named oti burial permit
Official Funeral Directors Reg.or License#