Giles, Warren William ) g Li 13
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records : Bur
Name First Middle Last Sex
Warren William Giles Male
Date of Death Age If Veteran of U.S.Armed Forces,
05/18/2022 81 Years War or Dates Unknown. .
i_ Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death Undetermined Pending
W Natural Cause Accident Homicide Suicide g
Circumstances Investigation
W Medical Certifier Name Title
G Abigail Macomber PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 272
Burial Date Cemetery,Crematory or Facility Name
® 05/20/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
O. Date Point of
V)❑Transportation Shipment
0 by Common
Carrier Destination
Disinterment
Date Cemetery Address
0 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
I—. Remains are Shipped,If Other than Above
2 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/19/2022 Registrar of Vital Statistics .`Megan Nolin(ECectronica1TySigned)
(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:
Z Date of Disposition 5-1Z0 I ZZ Place of Disposition
h
2 (address)
W
NCC (section) (lot number (grave number/
gName of Sexton or Person in Charge of P emises iht q �- it
zVplease print) ,+;
W Signature /� Title ti VriPit
g �/
DOH-1555(07/18)p 1 of 2
'r`
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# 1•