Vernum, Walter E oLF ,
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NEW YORK STATE DEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Walter E.Vemum Male
Date of Death Age If Veteran of U.S.Armed Forces,
08/27/2022 82 Years War or Dates
F Place of Death Hospital,Institution or
Z City,Town or Village Schenectady Street Address Ellis Hospital
a Manner of Death EI Natural Cause Accident El Homicide Duicide ❑Undetermined ❑Pending
W Circumstances Investigation
WMedical Certifier Name Title
G Leslie Parikh MD
Address
1101 Non St,Schenectady,New York 12308
DeaAth Certificate Filed city of Schenectady District Number Register Number
City,Town or Village 4801 773
Burial Date Cemetery,Crematory or facility Name
09/01/2022 Pine View Crematory
Entombment Address
Cremation Oueensbury Town,New York
Donation
❑Removal Date Place Removed
F and/or and/or Held
N Hold Address
0
d Date Point of
(A Transportation Shipment
Q by Common
Carrier Destination
Disinterment
Date Cemetery Address
D Re interment
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
2 Address
l=
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/31/2022 Registrar of Vital Statistics Samwrta 4e MAK)(*Flct>zttcaaji.4/rud)
(signature)
District Number 4601 Place City Of Schenectady
I certify that the remains of the decedent identified above were disposed of in accordance with this permiton:
WDate of Disposition 4 if 17Z Place of Disposition 0.A i.. 66 ri-
2 (address)
W
W
♦Z (section) n (/01 number) c (gra►e number)
Name of Sexton or Person in Charge of Premises nf�p� Sgtv,l ft
Z L /�/ (plerse print)
W Signature /� Title re I41
DOH 1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
View Cemetery Representing the funeral home named on burial permit
Funeral Directors Reg.or License#