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Rapp, Dale Health
.tt ICI NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records - Burial - Transit Permi Name First Middle Last Sex Dale Heath Rapp Male Date of Death Age If Veteran of U.S.Armed Forces, 02/10/2022 69 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital `p Manner of Death © Natural Cause Accident ❑Homicide ❑Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title G William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 103 Burial Date Cemetery,Crematory or Facility Name 02/14/2022 Pine View Crematory Entombment Address Cremation Queensbury Town,New York Donation 0 Removal Date Place Removed and/or and/or Held H Hold Address 0 O. Date Point of (I) Li Transportation p by Common Shipment Carrier Destination El 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 Remains are Shipped,If Other than Above 2 Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/14/2022 Registrar of Vital Statistics Megan.No(in(Electronwa1Ty 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: Z Date of Disposition Z fis I 7 t Place of Disposition 2,�—►.. 2 (address) W N (section) (lot number) (grave number) 8 Name of Sexton or Person in Charge of Premises M 44 Zj ease print) W Signature Title DOH-1555(07/18)p 1 of 2 - Public Health Law Sec. 4145(2b) 6 `r„ Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#