Walker, Chester Joseph it i61'
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Chester Joseph Walker Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/20/2022 66 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death ❑X Natural Cause 12 Accident El Homicide Suicide Undetermined Pending
C.) Circumstances Investigation
LU Medical Certifier Name Title
l0 Mathew Varughese DO
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 121
Burial Date Cemetery,Crematory or Facility Name
02/23/2022 Pine View Crematory
❑Entombment Address
0 Cremation Queensbury Town,New York
0 Donation
ZO Removal Date Place Removed
and/or and/or Held
NF— Hold Address
0
d Date Point of
U) Li Transportation Shipment
p by Common
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
Reinterment
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
g Address
tr
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/23/2022 Registrar of Vital Statistics Zoe Morgan(E/ctronicaf 5ignea)
(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:
WDate of Disposition 2413 I ZZ Place of Disposition (address)t
W
CC (section) d (lot number/ (grave number)
Name of Sexton or Person in Charge of P ises 1;1,4- St
ease print)
Z C Ii M
W Signature _ Title
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) JY 5 "
1
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#