Detmer, Christopher NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Christopher Detmer Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/24/2022 80 Years War or Dates 1961-1964
F• Place of Death Hospital,Institution or
WCity,Town or Village Granville Village Street Address Granville Center for Rehabilitation and Nursing
0 Manner of Death E Natural Cause ❑Accident 11 Homicide OSuicide ❑Undetermined ❑Pending
ILI
V Circumstances Investigation
�W Medical Certifier Name Title
Shardul Kopper DO
Address
17 Madison St,Granrvile Village,New York 12832
Death Certificate Filed village of Granville District Number Register Number
C' ,TownorVillle 5725 18
Burial , Date Cemetery,Crematory or Facility Name
04/26/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Removal Date Place Removed
and/or and/or Held
N Hold Address
0
d Date Point of
N Transportation
by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
2 Address
It
W
CI. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/26/2022 Registrar of Vital Statistics 4ejclarJRp6erts(2finrmntcaQ,sg4
(signature)
District Number 5725 Place Village Of Granville
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W � 2g,
Date of Disposition 1IZZ Place of Disposition 47^J (i+.-
2 (address/
W
OC OC (section) 4(lot number) (grave number)
SName of Sexton or Person in Charge of Premises /D L- ,c4itt
z (pleas rift)
W Signature Title 11"Ve
DOH-1555(o7/18)p i of 2
A J...!
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#