Augustine, Joseph David NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name . First Middle Last Sex
Joseph David Augustine Male
f Date of Death Age If Veteran of U.S.Armed likes
,p
04/15/2022 37 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address 45 William Street,Glens Falls,New York 12804
11/
ua Manner of Death ri Natural Cause nAccident ri Homicide Suicide Undetermined ❑Pending
V Circumstances Investigation
0 Medical Certifier Name Title
,t3. Connie Goedert Coroner
Address
1400 St Route 9,Lake George Town,New York 12845
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 216
Burial Date Cemetery,Crematory or Facility Name
*^04/19/2022 Pine View Crematory
Entombment P.Address
:'
Cremation Queensbury Town,New York
> Donation
Z'Z,, ❑Removal Date Place Removed
and/or and/or Held
f- Hold Address
CD
Lr Date Point of
CO OTransportation
8by Common Shipment
Carrier Destination
,_ Date Cemetery Address
Disinterment
Reinterment
Date Cemetery Address
Permit Issued to r 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
.ram+ Address
CIC
ILI
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/18/2022 Registrar of Vital Statistics MeganWoliin(ECectronica1TySigned)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition ii 120 122 Place of Disposition ?IL` —:
iu (address)
Ili
Ce (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Pr mises 16.4 4L.
W /pase print) /` /�
Signature Title l c/�'or'Ir-
DOH-1555(018)p 1 of 2
l ;
w .. S
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# /