Golden, Thomas M it 307
NEW YORK STATE DEPARTMENT OF HEALTH - Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Thomas M.Golden Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/01/2022 53 Years War or Dates
Place of Death Hospital,Institution or
City,Town or Village Thurman Town Street Address 675 Garnet Lake Road,Thurman Town,New York 12810
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0 Manner of Death ❑X Natural Cause Accident ri Homicide Suicide illUndetermined Pending
Circumstances Investigation
ILI Medical Certifier Name Title
QPaul Bachman MD
R Address
t' 9 Carey Rd,Queensbury Town,New York 12804
Death Certificate Filed Town Of Thurman District Number Register Number
City,Town or Village 5659 6
'0 Burial Date Cemetery,Crematory or Facility Name
04/07/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
,. Donation
cirjRemoval Date Place Removed
and/or and/or Held
Hold Address
0
11 Date Point of
(I) Transportation
p by Common Shipment
.',. Carrier Destination
Disinterment Date_ Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
i+ Name of Funeral Home Alexander Baker Funeral Home 00037
Address
1 3809 Main St,Warrensburg,New York 12885
- Name of Funeral Firm Making Disposition or to Whom
14- Remains are Shipped,If Other than Above
2 Address
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' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/06/2022 Registrar of Vital Statistics Cynthia cR,7fyde(EfectronicalTySigned)
(signature)
District Number 5659 Place Town Of Thurman
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H �
W Date of Disposition ZpxZ Place of Disposition V . � ( ,A .€u) 0pe 44 Ail
2 (address)
W
ITt (section) J (lot n ber)• (grave number)
V Name of Sexton or Person in Cha of Premi )`i1 j ioei ,
W (please print)
Signature Title Ore-77i.�-e—
DOH-1555(07/18)p 1 of 2
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#