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Bretzel, Erwin J NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Erwin J.Bretzel Male Date of Death Age If Veteran of U.S.Armed Forces, 01/28/2022 84 Years War or Dates Korea Place of Death Hospital,Institution or Z City,Town or Village Warrensburg Town Street Address 3810 Main Street,Warrensburg Town, New York 12885 p Manner of Death © Natural Cause El Accident El Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title O Paul Bachman MD Address 9 Carey Rd,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Warrensburg 5660 4 ❑Burial Date Cemetery,Crematory or Facility Name 02/03/2022 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation Z ❑Removal Date Place Removed and/or and/or Held ~ Hold Address O a Date Point of U) ❑Transportation Q by Common Shipment Carrier Destination Date Cemetery Address ❑Disinterment ❑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 f. Remains are Shipped,If Other than Above S Address EC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/03/2022 Registrar of Vital Statistics (Pamela M Lloyd(Electronically Signed) (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: WDate of Disposition 2. - 4-g- _ Place of Disposition 1� V..cuj 2 (a dress) W CC (section) (lot number) (grave number) 8 Name of Sexton or Perso in Charge of Premises 3f/"t)' S j r-t.,S Z (please print) W Signature / Title CR./014a DOH-1555(07/18)p 1 of 2 0 1. i 6U9 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#