Carpenter, Jamie S it
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NEW YORK STATE DEPARTMENT OF HEALTH _".-/
Burial - Transit Permit
Bureau of Vital Records
Name First Middle last Sex
Jamie S.Carpenter Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/14/2022 48 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Thurman Town Street Address 1272 River Road,Thurman Town,New York 12885
p Manner of Death ❑Natural Cause Accident n Homicide Suicide Undetermined Pending
U' Circumstances Investigation
ILI Medical Certifier Name Title
0 Connie Goedert Coroner
Address
1400 St Route 9,Lake George Town,New York 12845
Death Certificate Filed Town Of Thurman District Number Register Number
City,Town or Village 5659 10
Burial Date Cemetery,Crematory or Facility Name
s 07/22/2022 Pine View Crematory
Entombment— Address
EICremation Queensbury Town,New York
Donation
Z Date Place Removed
0 Removal
and/or and/or Held
f- Hold Address
N
0
a Date Point of
U)❑Transportation
a by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
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
N Address
Et
ILI
13. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/22/2022 Registrar of Vital Statistics Cynthia`R,Nyrle(`ECectronicaCCySigned)
(signature)
District Number 5659 Place Town Of Thurman
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
II— +/
Z Date of Disposition '7I a/' t O IL��Place of Disposition A-p--,..
in
2 (address)
W
N
C (section) Jf (lot number) (grave number)
0 Name of Sexton or Person in Ch of Premisesease�Il�^sp/�-Prrn1tH
Z
)
W Signature Title �f ��
DOH-15551o7/t8)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of 1` ' delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# %'