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Parent, Wayne M
NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Wayne M.Parent Male Date of Death Age If Veteran of U.S.Armed Forces, 01/21/2022 51 Years War or Dates F Place of Death Hospital,Institution or WCity,Town or Village Warrensburg Town Street Address 3664 Main Street 17,Warrensburg Town,New York 12885 p Manner of Death ©Natural Cause Accident Homicide Suicide Undetermined Pending W V Circumstances Investigation a Medical Certifier Name Title Lynn Keil PA Address 1340 State Route 9,Lake Ge&rge Town, New York 12845 Death Certificate Filed District Number Register Number City,Town or Village Warrensburg 5660 3 ElBurial Date Cemetery,Crematory or Facility Name 01/25/2022 Pine View Crematory El Entombment Address 0 Cremation Queensbury Town,New York ❑Donation 0 Removal Date Place Removed . F and/or and/or Held N Hold Address 0 ((I) ❑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 i— Remains are Shipped,If Other than Above 2 Address CC W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/25/2022 Registrar of Vital Statistics Pamela MG(oyd(ffEectronica(CySigned) (signature) District Number 5660 Place Warrensburg, 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 12� 2Z Place of Disposition '„a y„ .- dry_ 2 (address) Ili Q (section) (lot number) (grave number) gName of Sexton or Person in Charge of Premises itif t-- .. Mnt tr Z (please print) W Signature Title Ili- nwrt ' — DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) I iReceipt 1 Human remains of ," ' ;', delivered on , , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#