Denton, Thomas George 57)
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Thomas George Denton Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/19/2022 72 Years War or Dates
ii Place of Death Hospital,Institution or
Z City,Town or Village Stony Creek Town Street Address 93 Hadley Rd,Stony Creek Town,New York 12878
Ulf
W Manner of Death ID Natural Cause []Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
0 Sarah Durkee PA
Address
9 Carey Road,Queensbury Town,New York 12804
DeaEth Certificate Filed Town Of Stony Creek District Number Register Number
City,Town or Village 5658 5
Burial Date Cemetery,Crematory or Facility Name
07/21/2022 Pine View Crematory
Entombment Address
EICremation Queensbury Town,New York
Donation
O�Removal Date Place Removed
and/or and/or Held
N
Hold Address
0
a. Date Point of
N Ill Transportation
by Common Shipment
p
Carrier Destination
Disinterment Date Cemetery Address
Date Cemetery Address
El Reinterment
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
F- Remains are Shipped,If Other than Above
Address
IX
W
12" Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/21/2022 Registrar of Vital Statistics Susan I7farrington(Electronically Signed)
(signature)3 District Number 5658 Place
Town Of Stony Creek
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
/I
Z Date of Disposition 7 i 21 171. Place of Disposition
�(....W
2 (address)
Wcn
ir (section) (lot number) shvvo
(grave number)
ci Name of Sexton or Person in Charge of P mises , l n,i 2. i
Z (p ase print)ILI / �y�
Signature Title (� *i�"
DOH-1555(018)p 1 of 2
f
1
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#