Adams, George Finiel 4- 6/?
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
George Finiel Adams Male
Date of Death Age If Veteran of U.S.Armed Forces,
08/01/2022 89 Years War or Dates
ZZPlace of Death Hospital,Institution or
City,Town or Village Glens Falls Street Address Glens Falls Hospital
UJ
p Manner of Death a Natural Cause Accident ri Homicide ESuicide Undetermined Pending
(Wj Circumstances Investigation
LLI G Medical Certifier Name Title
Mathew Varughese DO
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 404
—
Burial Date Cemetery,Crematory or Facility Name
08/03/2022 Pine View Crematory
Entombment Address
aCremation Queensbury Town,New York
Donation
Z❑Removal Date Place Removed
and/or and/or Held
H Hold Address
0
O. Date Point of
In❑Transportation
by Common Shipment
Carrier Destination
EIDisinterment Date Cemetery Address
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
Address
CC
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/03/2022 Registrar of Vital Statistics MeganWoliin(ECectronicattySigned)
(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:
I—
Z Date of Disposition e—y—zatz Place of Disposition ( , n1 e Cr 4,161 f�
2 (address)
W
N°C (section) (lot number) (grave number)
gName of Sexton or Person in Ch rge of Premi s i 7 - 1,0 bei A
Z (please print)
IW Signature 1 1 Title Oee!
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral lime-named on bunal permit
Official Funeral Directors Reg.or License# '