Jones, Anthony Joseph it
NEW YORK STATE DEPARTMENT OF HEALTH S60
Bureau of Vital Records ._. Burial - Transit Permit
Name First Middle Last
Anthony Joseph Jones Sex
Date of Death Male
Age f If Veteran of U.S.Armed Forces,
07/12/2022 75 Years I War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
WQ Manner of Death El Natural Cause ❑Accident LI Homicide OSuicide FlUndetermined n Pending
W
C3 Circumstances Investigation
QW Medical Certifier Name Title
Howard Silverberg MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number
City,Town or Village 5601 Register Number
364
i=Burial Date Cemetery,Crematory or Facility Name
II07/15/2022 Pine View Crematory
Entombment Address
EilCremation Queensbury Town,New York
Donation
,,,so Removal Date Place Removed
p and/or and/or Held
N Hold Address
0
IL Date Point of
V) ■Transportation
0 by Common Shipment
Carrier Destination
[DisintermentDate Cemetery Address
Date Cemetery Address
■ Reinterment
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
Remains are Shipped,If Other than Above
a Address
CC
W
C' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/15/2022 Registrar of Vital Statistics Megan Wolin(ECectronicallySigned)
(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:
W Date of Disposition 7 J/—7�L Place of Disposition lie J�.ems e r e.,i 4-40 r
(address)
W
N
CC
(section) (lot number) (grave number)
Name of Sexton or Person in Cha of Pre i s 1Q /Yf d� f de)
Z (please print
W r-
Signature a Title o(Ps w
DOH-1555(07/18)p i of 2
•
F n.R 'A)'F t3 S!
Public Health Law Sec. 4145(2b)
Receipt
Human remains of ` < delivered on -' , 20
•
•
Pine View Cemetery Representing the funeral home named on buri7l permit
Official Funeral Directors Reg. or License#