Jennings, Giles B Sr. NEWYORKSTATE DEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Giles B.Jennings Sr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/02/2022 79 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Thurman Town Street Address 40 Cameron Road,Thurman Town,New York 12810
Manner of Death ID Natural Cause DAccident Homicide ❑Suicide rillndetermined ❑Pending
W Circumstances Investigation
W Medical Certifier Name Title
C Paul Bachman MD
Address
9 Carey Rd,Oueensbury Town,New York 12804
Death Certificate Filed Town Of Thomran District Number Register Number
Cit ,Town or Village
g 5659 5
Burial Date Cemetery,Crematory or Facility Name
041ti52022 Pine View Crematory
Entombment Address
Cremation Oueensbury Town,New York
Donation
QDRemoval Date Place Removed
F and/or and/or Held
— Hold Address
CA
O. Date Point of
N❑Transportation Shipment
Q by Common
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
D Re interment
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
a Address
Q
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/0512022 Registrar of Vital Statistics Craig C.71 24(2'Gct 4wsd}
(signature)
District Number 5659 Place Town Of Thunman
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition if IS11Z Place of Disposition ,y� (04.0
W /addess/
W
NCC (section) (lot number) (gram.number)
8 Name of Sexton or Person in Charge of Premises A/!sp.�,,11r
Z 4,/ (ple print)
W Signature /.C.: Title ��6M���
DOH-1555(07/18)p t 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#