Dunkley, George Jr. NEW YORK STATE DEPARTMENT OF H EALTH - VLOF
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
George Durtldey Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/12/2022 81 Years War or Dates
F Place of Death Hospital,Institution or
F. City,Town or Village Johnsburg Town Street Address Elderwood at North Creek
G
MannerofDeath EINaturalCause ❑Accident Homicide ❑Suicide Undetermined ❑Pending
W
V Circumstances Investigation
W Medical Certifier Name Title
CI Eric Santell NP
Address
112 Ski Bowl Rd,Johnsburg Town,New York 12853
DeaAth Certificate Filed Town Of Johnsburg District Number Register Number
City,Town or Village 5655 7
Burial Date Cemetery,Crematory or Facility Name
04/1412022 Pine View Crematory
Entombment Address
ECremation Queensbury Town,New York
Donation
Q❑Removal Date Place Removed
p and/or and/or Held
— Hold Address
CO
O. Date Point of
th❑Transportation
G by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
DReinterment
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
1— Remains are Shipped,If Other than Above
2 Address
CC
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued O4/13/2022 Registrar of Vital Statistics jean A'Conxsto €( I 7mni.a*Srgnao9
/signature/
District Number 5655 Place Town Of Johnsburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition y-/3-2ci22 Place of Disposition hiti G..,_J ( f4,14.alr.h
(add-es)
W
CC QN (section) (lot number) (grave number)
Ll
Name of Sexton or Person in rge of Premises .,, 1 rZ✓� ('G-WI�-C.�.,
Z (please print)
{Y Signature /�
�1...!' 7 �.J+,Title C ie,.,,ti,�vey Oi efE,
DOH-1555(07/18)p 1 of 2
i 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# F'