Neil, Kenneth Edward . / , (1....... F) .0 /,
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Kenneth Edward Neil Mal
Date of Death Age If Veteran of U.S.Armed Forces,
05103/2022 61 Years War or Dates
(`- Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Liens Falls Hospital
iti
„ja Manner of Death ❑X Natural Cause Accident Ej Homicide OSukide ❑Undetermined ❑Pending
C.) Circumstances Investigation
w Medical Certifier Name Title
Matthew Loftus PA
Address
100 Park St,Glens Falls,New York 12801
DeaEth Certificate Filed City of Glens Fats District Number Register Number
City,Town or Village 5601 248
Burial Date Cemetery,Crematory or Facility Name
05105/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
MIRemoval Date Place Removed
and/or and/or Held
0 Hold Address
0. Date Point of
Transportation
by Common Shipment
Carrier Destination
ElDisinterment Date Cemetery Address
ElReinterment 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
F Remains are Shipped,If Other than Above
2 Address
a
.W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/05/2022 Registrar of Vital Statistics Megan Noin( tt StPn4
(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:
F-
W Date of Disposition `.i -s foz4 Place of Disposition r fie L2 e,,J Ct
2 (address
W
NCC (sedan) (lot umber/ (gram number)
8 Na: b0n017Z,,h/
re Title Ce��t 1►r"--
DOH-1555(07/18)p 1 of 2
! _
Public Health Law Sec. 4145(2b) y
Receipt
1 Human remains ; delivered 20
1 a sof dev eedon ,
1
I
Pine View Cemetery Representing the funeral horns named on burial permit
Official Funeral Directors Reg.or License#