Ehle, Daniel J 6y3NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
Name First Middle
Daniel J.Ehle Last Sex
Date of Death Age If Veteran of U.S.Armed Forces, Male
08/07/2022 56 Years
War or Dates
Place of Death
Z City,Town or Village Hospital,Institution or
{t� *; Glens Falls Street Address Glens Falls Hospital
p Manner of Death Natural Cause
(W X ❑Accident []Homicide SuicideFlUndetermined ❑Pending
ttJ Medical Certifier Name Circumstances Investigation
Title
Scott Biasetti MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number
City,Town or Village Register Number
5601 413
Burial Date Cemetery,Crematory or Facility Name
08/11/2022 Pine View Crematory
Entombment
Address
lCremation Queensbury Town,New York
EiDonation
Date Place Removed
0 Removal
and/or and/or Held
Hold Address
co
CL Date Point of
CO❑Transportation
CI by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
■Reinterment Date Cemetery Address
Permit Issued to
Name of Funeral Home Alexander Baker Funeral Home Registration Number
00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
_ Remains are Shipped,If Other than Above
a Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/10/2022 Registrar of Vital Statistics Megan NoCn(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:
W Date of Dis osition —'�L
p g(l Z(z2 Place of Disposition
(address)
W
N
CC
(section) (lot number) (grave number)
Name of Sexton or Person in Cha of Premises 0- �-- Snevi
"
ilease print)
Signature Title �fz
EU,DOH-1555(ol/18)p t of 2
r`:e ... 7
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
1
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#